Information Collection

Baseline data collection – study participants

IC 227914 under ICR 202003-0970-002 · OMB 0970-0506.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0506 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment B Coaching Baseline Questionnaire_PUBLIC_v8_clean.docx	Other-Survey
Attachment J Baseline Survey QxQ_PUBLIC_v7_clean.docx Attachment J - Question-by-Question Justification - Baseline	IC Document

IC Title:

Baseline data collection â study participants

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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			Attachment B Coaching Baseline Questionnaire_PUBLIC_v8_clean.docx		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: 1,977

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	Previously Approved
Annual Number of Responses for this IC	1,977	1,977
Annual IC Time Burden (Hours)	653	653
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment J - Question-by-Question Justification - Baseline	Attachment J Baseline Survey QxQ_PUBLIC_v7_clean.docx	03/14/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.