Information Collection

Feedback on Mixed-Delivery System and Service Coordination to Inform Appropriate, Tailored and Timely Technical Assistance

IC 235518 under ICR 201801-0970-013 · OMB 0970-0401.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0401 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
PDG Feedback Questions 3.28.19.docx	Other-Survey
Fast Track Generic - Submission Template Draft 3.28.19.doc Fast Track Generic - Submission Template PDG B-5 Grantees	IC Document

IC Title:

Feedback on Mixed-Delivery System and Service Coordination to Inform Appropriate, Tailored and Timely Technical Assistance

Agency IC Tracking Number:

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
Other-Survey			PDG Feedback Questions 3.28.19.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: 46

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
Annual Number of Responses for this IC	46	46
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track Generic - Submission Template PDG B-5 Grantees	Fast Track Generic - Submission Template Draft 3.28.19.doc	03/29/2019

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