Information Collection

Instrument 12: Short-Term Follow-up Survey for the HPOG 2.0 National Evaluation Impact Evaluation

IC 229940 under ICR 201904-0970-006 · OMB 0970-0462.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0462 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 12 HPOG2.0_Short-term 15-month Survey_REV 09262018_CleanCopy.docx	Other-Survey

IC Title:

Instrument 12: Short-Term Follow-up Survey for the HPOG 2.0 National Evaluation Impact Evaluation

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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					No		Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,981

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,981	-1,486	3,467
Annual IC Time Burden (Hours)	1,981	-1,486	3,467
Annual IC Cost Burden (Dollars)	0	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.

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