Information Collection

Attachment B.3: Baseline coach survey

IC 231359 under ICR 201807-0970-009 · OMB 0970-0508.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0508 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
B.3_VIQI OMB 30 Baseline Coach Survey_revised clean.docx	Other-Survey

IC Title:

Attachment B.3: Baseline coach survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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			B.3_VIQI OMB 30 Baseline Coach Survey_revised clean.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: 77

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
	Requested	Previously Approved
Annual Number of Responses for this IC	77	77
Annual IC Time Burden (Hours)	46	46
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.