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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Instrument 2_HPOG 2.0 National Evaluation Screening Interview_REVISED 4-21-17.docx Other-Screening Interview

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.