Information Collection

Focus Group Questionnaire

IC 228527 under ICR 201707-2528-004 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ConnectHome Expansion PRA Instrument QCA 8-28-17 - Focus group questionnaire.docx	Other-Focus Group Questionnaire

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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-Focus Group Questionnaire			ConnectHome Expansion PRA Instrument QCA 8-28-17 - Focus group questionnaire.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	396	396
Annual IC Cost Burden (Dollars)	11,880	11,880

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.