Information Collection

SHIP-SMP Survey of One-on-One Assistance

IC 225703 under ICR 202006-0985-004 · OMB 0985-0057.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0985-0057 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SHIP-SMP Survey of One-on-One Assistance	Form and Instruction
SHIP-SMP Survey of One-on-One Assistance 0057 1 on 1 Assistance Survey Final.docx	Form and Instruction

IC Title:

SHIP-SMP Survey of One-on-One Assistance

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
Form and Instruction	NA	SHIP-SMP Survey of One-on-One Assistance	0057 1 on 1 Assistance Survey Final.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: 800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	800	0	-550	1,350
Annual IC Time Burden (Hours)	80	-100	0	180
Annual IC Cost Burden (Dollars)	0	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.