Information Collection

Home Hazard Checklist (Baseline)

IC 250819 under ICR 202108-2528-001 · OMB 2528-0335.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2528-0335 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix D. Home Hazard Checklist Form_OAHM_Final.docx	Other-Home Hazard Checklist (Baselin
Appendix D. Home Hazard Checklist Form_OAHM_Final.docx	Other-Home Hazard Checklist (Baselin
Appendix D. Home Hazard Checklist Form_OAHM_FINAL_SPL.docx	Other-Home Hazard Checklist (Baselin
Appendix D. Home Hazard Checklist Form_OAHM_FINAL_SPL.docx	Other-Home Hazard Checklist (Baselin

IC Title:

Home Hazard Checklist (Baseline)

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Home Hazard Checklist (Baseline)			Appendix D. Home Hazard Checklist Form_OAHM_Final.docx		No		Paper Only
Other-Home Hazard Checklist (Baseline)			Appendix D. Home Hazard Checklist Form_OAHM_FINAL_SPL.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,000

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	3,000	3,000
Annual IC Time Burden (Hours)	1,260	1,260
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.