Evaluation of Older Americans Act Title VI - Tribal Elders Focus Group

Annual Performance Reporting of the Administration for Community Living’s American Indian, Alaskan Natives and Native Hawaiian Programs

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0985-0059 can be found here:

Documents and Forms

Document Name Document Type
Form 4 Evaluation of Older Americans Act Title VI - Tribal Elders Focus Group Form and Instruction
4 Title VI Elders Focus Group Title VI Tribal Elders Focus Group Moderator Guide.docx Form and Instruction
4 Tribal Elder Focus Group Consent Form Title VI Tribal Elder Focus Group Consent-2-2.docx Form

Information Collection (IC) Details

IC Title:	Evaluation of Older Americans Act Title VI - Tribal Elders Focus Group	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
Form and Instruction	4	Title VI Elders Focus Group	Title VI Tribal Elders Focus Group Moderator Guide.docx		No		Printable Only
Form	4	Tribal Elder Focus Group Consent Form	Title VI Tribal Elder Focus Group Consent-2-2.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-100	100
Annual IC Time Burden (Hours)	-200	200
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.