Instrument 5b: HPOG 2.0 National Evaluation letter and participant contact update form

OPRE Evaluation - National and Tribal Evaluation of the 2nd Generation of the Health Profession Opportunity Grants [descriptive evaluation, impact evaluation, cost-benefit analysis study, pilot study]

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0462 can be found here:

Documents and Forms

Document Name Document Type
Instrument 5b_ HPOG 2 0 National Evaluation Contact Update Letter and Form_Rev07112017_clean.docx Other-Update Form

Information Collection (IC) Details

IC Title:	Instrument 5b: HPOG 2.0 National Evaluation letter and participant contact update form	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-Update Form			Instrument 5b_ HPOG 2 0 National Evaluation Contact Update Letter and Form_Rev07112017_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: 8,193	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	16,386	1,887	14,499
Annual IC Time Burden (Hours)	2,122	672	1,450
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.