Information Collection

Pilot

IC 251738 under ICR 202202-0607-008 · OMB 0607-1020.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-1020 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Pilot Form and Instruction
1 DoD Baseline Questionnaire 17_DoD Baseline Questionnaire.docx Form and Instruction
1 DoD Baseline Questionnaire 17_DoD Baseline Questionnaire.docx Form and Instruction
2 English Baseline Questionnaire 27_Baseline Questionnaire_ENG.docx Form and Instruction
2 English Baseline Questionnaire 27_Baseline Questionnaire_ENG.docx Form and Instruction
3 English Screener Questionnaire 26_Screener Questionnaire_ENG.docx Form and Instruction
3 English Screener Questionnaire 26_Screener Questionnaire_ENG.docx Form and Instruction
4 Spanish Baseline and Screener Questionnaire 26_Screener and Baseline_SPA.xlsx Form and Instruction
4 Spanish Baseline and Screener Questionnaire 26_Screener and Baseline_SPA.xlsx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Pilot	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	Available Electronically?	Electronic Capability
Form and Instruction	1	DoD Baseline Questionnaire	17_DoD Baseline Questionnaire.docx	No	Fillable Fileable
Form and Instruction	2	English Baseline Questionnaire	27_Baseline Questionnaire_ENG.docx	No	Fillable Fileable
Form and Instruction	3	English Screener Questionnaire	26_Screener Questionnaire_ENG.docx	No	Fillable Fileable
Form and Instruction	4	Spanish Baseline and Screener Questionnaire	26_Screener and Baseline_SPA.xlsx	No	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,400	3,400
Annual IC Time Burden (Hours)	1,131	1,131
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.