Information Collection

Implementation site data collection

IC 203225 under ICR 201711-0970-001 · OMB 0970-0398.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
PREP PAS+Baseline - Instrument 3 - Implementation Site Data Collection - 6-7-12.docx	Other-Data Collection

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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-Data Collection			PREP PAS+Baseline - Instrument 3 - Implementation Site Data Collection - 6-7-12.docx		No	No	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,400

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-1,400	1,400
Annual IC Time Burden (Hours)	-11,200	11,200
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.