Information Collection

Participant Information Forms

IC 213597 under ICR 202103-0985-001 · OMB 0985-0039.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0985-0039 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Participant Information Forms	Form and Instruction
Participant Form 0039 Participant-Information-Form (1).pdf	Form and Instruction
Participant Form 0039 Participant-Information-Form (1).pdf	Form and Instruction
Post Session Survey 0039 Post Session Survey (2).pdf	Form and Instruction
Post Session Survey 0039 Post Session Survey (2).pdf	Form and Instruction

IC Title:

Participant Information Forms

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Participant Form	0039 Participant-Information-Form (1).pdf		Yes	Yes	Fillable Fileable
Form and Instruction	NA	Post Session Survey	0039 Post Session Survey (2).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: 16,728

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	16,728	-9,496	26,224
Annual IC Time Burden (Hours)	1,674	-948	2,622
Annual IC Cost Burden (Dollars)	0	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.