Information Collection

#3. Home-Based Provider Interview

IC 198388 under ICR 201808-0970-002 · OMB 0970-0391.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0391 can be found here:

Documents and Forms

Document Name Document Type
3. Home_Based Provider Questionnaire.doc Other-#3. Home-Based Provider Interv

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	#3. Home-Based Provider Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-#3. Home-Based Provider Interview			3. Home_Based Provider Questionnaire.doc		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: 10,710	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-10,710	10,710
Annual IC Time Burden (Hours)	-5,355	5,355
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.