Information Collection

Survey of Elder Justice Needs in Rural America

IC 231047 under ICR 201804-1105-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1105- NEW Survey of Elder Justice Needs in Rural America	Form and Instruction
1105- NEW Elder Justice Rural Survey Elder Justice Rural Survey 1105-NEW.docx survey.max.gov/357288	Form and Instruction

IC Title:

Agency IC Tracking Number:

1105-NEW

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	1105- NEW	Elder Justice Rural Survey	Elder Justice Rural Survey 1105-NEW.docx	https://survey.max.gov/357288	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: 5,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	2,500	2,500
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.