Household survey

The Outcomes Evaluation of the Choice Neighborhoods Program

Documents and Forms

Document Name Document Type
Final-4-27-21-Appendix A_Household Survey.docx Other-Household Survey
Final-4-27-21-Appendix A_Household Survey.docx Other-Household Survey

Information Collection (IC) Details

IC Title:	Household survey	Agency IC Tracking Number:

Is this a Common Form? No		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
Other-Household Survey			Final-4-27-21-Appendix A_Household Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,388	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,388	2,388
Annual IC Time Burden (Hours)	1,385	1,385
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.