Background Information Form (Previously titled Young Adult Baseline Survey)

Transition Living Program Evaluation

Documents and Forms

Document Name Document Type
C_Young Adult Background Information Form_071620_clean_for OMB.docx Other-Survey
Memo_TLP YOS_NonSub Change Request_final_071620.docx Memo - NonSub Change - COVID-19 IC Document

Information Collection (IC) Details

IC Title:	Background Information Form (Previously titled Young Adult Baseline Survey)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey			C_Young Adult Background Information Form_071620_clean_for OMB.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: 400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	400	200	200
Annual IC Time Burden (Hours)	112	-12	124
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Memo - NonSub Change - COVID-19	Memo_TLP YOS_NonSub Change Request_final_071620.docx	07/24/2020

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