Information Collection Request

Family Self-Sufficiency Program Evaluation

ICR 201707-2528-005 · OMB 2528-0296 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form XX-XXXX FSS Evaluation Form Removed Available
PCLIA FSS (rcg 10.20.17).pdf Supplementary Document Uploaded 2017-11-27 Available
PTA_FSS Evaluation_Impact Analysis (v.3).pdf Supplementary Document Uploaded 2017-11-27 Available
11-15-17 final - X_FSS National Evaluation - OMB Supporting Statement B.docx Supporting Statement B Uploaded 2017-11-27 Available
X_FSS National Evaluation - OMB Supporting Statement A - final 03-02-2018.docx Supporting Statement A Uploaded 2018-03-06 Available
60-Day Notice.pdf Supplementary Document Uploaded 2017-07-26 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
229144 FSS PHA Staff Interviews Pre-Interview Other-FSS PHA Staff Interviews Pre-Interview New
229142 PHA Staff Interviews (telephone) Other-PHA Staff Interviews (telephone) New
229141 PHA Staff Interviews (on-site) Other-PHA Staff Interviews On Site Case Managers New
229140 Study Participant Interviews Other-Study Participant Interviews New
205698 FSS Evaluation Form Removed

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2021 36 Months From Approved 10/31/2019
144 0 2,551
199 0 1,913
2,612 0 0





Reginfo record details
4
table that charts list of burden
IC Title Form No. Form Name
FSS Evaluation Baseline Information Form Adult, XX-XXXX, XX-XXXX, XX-XXXX Informed Consent ,   Baseline Information Form-Head of Household ,   XX-XXXX ,   36 Month Follow-up Survey
Study Participant Interviews
PHA Staff Interviews (on-site)
PHA Staff Interviews (telephone)
FSS PHA Staff Interviews Pre-Interview

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 144 2,551 0 -2,407 0 0
Annual Time Burden (Hours) 199 1,913 0 -1,714 0 0
Annual Cost Burden (Dollars) 2,612 0 0 2,612 0 0


Reginfo record details
  No