Information Collection

Baseline Information Form (household survey)

IC 254350 under ICR 202204-2528-001 · OMB 2528-0339.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2528-0339 can be found here:

Documents and Forms

Document Name Document Type
Final - Attachment A STRD Baseline Information Form.docx Other-Baseline Information Form (hou
Final - Attachment A STRD Baseline Information Form.docx Other-Baseline Information Form (hou

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Baseline Information Form (household survey)	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Baseline Information Form (household survey)			Final - Attachment A STRD Baseline Information Form.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: 24,000	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	24,000	24,000
Annual IC Time Burden (Hours)	2,880	2,880
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.