Information Collection

Program Impact Evaluations (Level 3 Evaluations)

IC 242945 under ICR 202007-1190-001 · OMB 1190-0021.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1190-0021 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1190-NEW Program Impact Evaluations (Level 3 Evaluations)	Form and Instruction
1190-NEW Program Impact Evaluations (Level 3 Evaluations) Level 3 Evaluations Interview Scripts.docx	Form and Instruction
1190-NEW Program Impact Evaluations (Level 3 Evaluations) 2021_02_05 CRS Level 3 Evaluations_Interview Questions.docx	Form and Instruction

IC Title:

Program Impact Evaluations (Level 3 Evaluations)

Agency IC Tracking Number:

1190-NEW

IC Status: New

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	1190-NEW	Program Impact Evaluations (Level 3 Evaluations)	2021_02_05 CRS Level 3 Evaluations_Interview Questions.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: 90

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	90	90
Annual IC Time Burden (Hours)	90	90
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.