Information Collection

6-Month Follow-Up Participant Interview (Attachment J)

IC 243384 under ICR 202112-0970-013 · OMB 0970-0537.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0537 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
J_6-Month Follow-Up Participant Survey_Phase 2_CLEAN.docx	Other-Participant Survey
J_6-Month Follow-Up Participant Survey_Phase 2_CLEAN.docx	Other-Participant Survey
BEES_Survey_FranklinStark_6MInstru_20210804_Clean.docx	Other-Participant Survey - Franklin
BEES_Survey_FranklinStark_6MInstru_20210804_Clean.docx	Other-Participant Survey - Franklin

IC Title:

6-Month Follow-Up Participant Interview (Attachment J)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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-Participant Survey			J_6-Month Follow-Up Participant Survey_Phase 2_CLEAN.docx		No		Paper Only
Other-Participant Survey - Franklin Stark			BEES_Survey_FranklinStark_6MInstru_20210804_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: 800

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	Previously Approved
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	200	200
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.