Information Collection

Second Follow-Up Survey

IC 207455 under ICR 201711-0970-001 · OMB 0970-0398.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
New Instrument # 5 - Master Follow-Up Survey.docx	Other-Survey
New Instrument #6 - HFSA Follow-Up Survey.docx	Other-Survey

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-Survey			New Instrument # 5 - Master Follow-Up Survey.docx		Yes	Yes	Fillable Fileable
Other-Survey			New Instrument #6 - HFSA Follow-Up Survey.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: 325

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	325	-425	750
Annual IC Time Burden (Hours)	244	-319	563
Annual IC Cost Burden (Dollars)	0	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.