Information Collection

Immediate Survey

IC 238583 under ICR 202007-0970-012 · OMB 0970-0539.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 1. NHTH Immediate Survey_Final_NonSubChange_clean.docx	Other-Survey
NHTH_NonSub Change Request.docx Memo - NonSub Change - July 2020	IC Document

IC Title:

Immediate Survey

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			Instrument 1. NHTH Immediate Survey_Final_NonSubChange_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: 2,000

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	2,000	2,000
Annual IC Time Burden (Hours)	240	240
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Memo - NonSub Change - July 2020	NHTH_NonSub Change Request.docx	07/24/2020

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