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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.