Information Collection

Survey Instrument for Local Agency Staff-Form B Differential Response

IC 229648 under ICR 201801-0970-001 · OMB 0970-0511.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Survey Instrument for Local Agency Staff-Form B Differential Response	Form and Instruction
1 Survey Instrument for Local Agency Staff-Form B Diff Attachment 9 - Survey Instrument for Local Agency Staff - Form B Diff Final.docx	Form and Instruction

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
Form and Instruction	1	Survey Instrument for Local Agency Staff-Form B Diff	Attachment 9 - Survey Instrument for Local Agency Staff - Form B Diff Final.docx		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	25	25
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.