Information Collection

4: Entrance and Exit Surveys - Program clients (exit)

IC 246007 under ICR 202102-0970-014 · OMB 0970-0566.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0566 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment H_Instrument 4HM_2_Adult_ExitSurvey.docx	Other-HM Adult Exit Survey
Attachment H_Instrument 4HM_2_Adult_ExitSurvey.docx	Other-HM Adult Exit Survey
Attachment H_Instrument 4HM_4_Youth_ExitSurvey.docx	Other-HM Youth Exit Survey
Attachment H_Instrument 4HM_4_Youth_ExitSurvey.docx	Other-HM Youth Exit Survey
Attachment H_Instrument 4RF_2_CommunityFathers_ExitSurvey.docx	Other-RF Community Fathers Exit Surv
Attachment H_Instrument 4RF_2_CommunityFathers_ExitSurvey.docx	Other-RF Community Fathers Exit Surv
Attachment H_Instrument 4RF_4_CommunityMothers_ExitSurvey.docx	Other-RF Community Mothers Exit Surv
Attachment H_Instrument 4RF_4_CommunityMothers_ExitSurvey.docx	Other-RF Community Mothers Exit Surv
Attachment H_Instrument 4RF_6_ReenteringFathers_ExitSurvey.docx	Other-RF Reentering Fathers Exit Sur
Attachment H_Instrument 4RF_6_ReenteringFathers_ExitSurvey.docx	Other-RF Reentering Fathers Exit Sur

IC Title:

4: Entrance and Exit Surveys - Program clients (exit)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-HM Adult Exit Survey	Attachment H_Instrument 4HM_2_Adult_ExitSurvey.docx	Yes	Yes	Fillable Fileable
Other-HM Youth Exit Survey	Attachment H_Instrument 4HM_4_Youth_ExitSurvey.docx	Yes	Yes	Fillable Fileable
Other-RF Community Fathers Exit Survey	Attachment H_Instrument 4RF_2_CommunityFathers_ExitSurvey.docx	Yes	Yes	Fillable Fileable
Other-RF Community Mothers Exit Survey	Attachment H_Instrument 4RF_4_CommunityMothers_ExitSurvey.docx	Yes	Yes	Fillable Fileable
Other-RF Reentering Fathers Exit Survey	Attachment H_Instrument 4RF_6_ReenteringFathers_ExitSurvey.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: 169,965

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	56,088	56,088
Annual IC Time Burden (Hours)	23,795	23,795
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.