Information Collection

Follow-up survey for adults (Instrument 11)

IC 220540 under ICR 202005-0970-006 · OMB 0970-0481.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 11_STREAMS Adult FUP survey (3-2-17)_edited_6-21-17 _clean.docx	Other-Follow up Survey

IC Title:

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-Follow up Survey			Instrument 11_STREAMS Adult FUP survey (3-2-17)_edited_6-21-17 _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: 767

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	767	767
Annual IC Time Burden (Hours)	575	575
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.