Information Collection

Instrument 1: Staff data entry on participant baseline information

IC 227871 under ICR 202002-0970-003 · OMB 0970-0505.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0505 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 1_Staff Data Entry on Participant Baseline Information_20200206.docx	Other-Baseline Data Entry

IC Title:

Instrument 1: Staff data entry on participant baseline information

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-Baseline Data Entry					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: 50

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	1,700	-4,300	6,000
Annual IC Time Burden (Hours)	85	-215	300
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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