Information Collection

Instrument 2: Screening Interview to identify respondents for the HPOG 2.0 National Evaluation first-round telephone interviews

IC 224093 under ICR 201707-0970-001 · OMB 0970-0462.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0462 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 2_HPOG 2.0 National Evaluation Screening Interview_REVISED 4-21-17.docx	Other-Screening Interview

IC Title:

Instrument 2: Screening Interview to identify respondents for the HPOG 2.0 National Evaluation first-round telephone interviews

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screening Interview			Instrument 2_HPOG 2.0 National Evaluation Screening Interview_REVISED 4-21-17.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	13	13
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.