Evaluation of the ACL Title VI Programs Title VI Program Staff Evaluation Follow-up Interview

Annual Performance Reporting of the Administration for Community Living’s American Indian, Alaskan Natives and Native Hawaiian Programs

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0985-0059 can be found here:

Documents and Forms

Document Name Document Type
Evaluation of the ACL Title VI Programs Title VI Program Staff Evaluation Follow-up Interview Form and Instruction
Title VI Program Staff Evaluation Follow-up Interview 0059 Evaluation follow up Consent and Guide.pdf Form and Instruction
Title VI Evaluation Follow-up Consent and Guide 0059 Evaluation follow up consent and guide priv update.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Evaluation of the ACL Title VI Programs Title VI Program Staff Evaluation Follow-up Interview	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
Form and Instruction	NA	Title VI Program Staff Evaluation Follow-up Interview	0059 Evaluation follow up Consent and Guide.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	NA	Title VI Evaluation Follow-up Consent and Guide	0059 Evaluation follow up consent and guide priv update.pdf		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: 12	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	12	-258	270
Annual IC Time Burden (Hours)	12	-482	494
Annual IC Cost Burden (Dollars)	0	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.