Information Collection

Baseline survey & Identifying and contact information – participants

IC 240714 under ICR 202204-0970-020 · OMB 0970-0545.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0545 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 1. NextGen baseline survey-revised.docx	Other-Survey
Instrument 1. NextGen baseline survey-revised.docx	Other-Survey
Instrument 2. Identifying and contact information-revised.docx	Other-Identifying and contact inform
Instrument 2. Identifying and contact information-revised.docx	Other-Identifying and contact inform

IC Title:

Baseline survey & Identifying and contact information â participants

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
Other-Survey			Instrument 1. NextGen baseline survey-revised.docx		Yes	Yes	Fillable Fileable
Other-Identifying and contact information			Instrument 2. Identifying and contact information-revised.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: 10,000

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	Previously Approved
Annual Number of Responses for this IC	3,333	3,333
Annual IC Time Burden (Hours)	1,400	1,400
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.