Information Collection

Evaluation of Older Americans Act Title VI Programs-Tribal Interview

IC 227560 under ICR 201902-0985-001 · OMB 0985-0059.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 5 Evaluation of Older Americans Act Title VI Programs-Tribal Interview	Form and Instruction
5 Title VI Tribal Elders Interview Title VI Tribal Elder Interview Guide.docx	Form and Instruction
5 Tribal Elders Interview Consent Form Title VI Tribal Elder Interview Consent-2-2.docx	Form

IC Title:

Evaluation of Older Americans Act Title VI Programs-Tribal Interview

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	5	Title VI Tribal Elders Interview	Title VI Tribal Elder Interview Guide.docx		No		Printable Only
Form	5	Tribal Elders Interview Consent Form	Title VI Tribal Elder Interview 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: 20

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-20	20
Annual IC Time Burden (Hours)	-20	20
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.