Information Collection

8 & 9 - Baseline surveys

IC 220979 under ICR 201710-0970-002 · OMB 0970-0485.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
9 - Baseline Survey for Sites Testing Employment Intervention.docx	Other-Baseline Survey
8 - Baseline Survey for Sites Testing Parenting Intervention Revised 9-16-16_clean.docx	Other-Survey
9 - Baseline Survey for Sites Testing Employment Intervention - screen shots.docx Baseline survey screen shots	IC Document
8 - Baseline Survey for Sites Testing Parenting Intervention Spanish 9-16-16.docx Baseline survey Parent Intervention - Spanish Version	IC Document

IC Title:

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-Baseline Survey			9 - Baseline Survey for Sites Testing Employment Intervention.docx		Yes	Yes	Fillable Fileable
Other-Survey			8 - Baseline Survey for Sites Testing Parenting Intervention Revised 9-16-16_clean.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: 947

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	947	947
Annual IC Time Burden (Hours)	608	608
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Baseline survey screen shots	9 - Baseline Survey for Sites Testing Employment Intervention - screen shots.docx	09/08/2016
Baseline survey Parent Intervention - Spanish Version	8 - Baseline Survey for Sites Testing Parenting Intervention Spanish 9-16-16.docx	09/30/2016

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