Information Collection

Adult Head of Household Survey (Appendix E)

IC 255852 under ICR 202206-2528-002 · OMB 2528-0259.

Documents and Forms

Document Name Document Type
Final - Appendix E_Adult HoH Survey.docx Other-Adult Head of Household Survey
Final 1-18-23-Appendix E_Adult HoH Survey.docx Other-Adult Head of Household Survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Adult Head of Household Survey (Appendix E)	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-Adult Head of Household Survey (Appendix E)			Final 1-18-23-Appendix E_Adult HoH Survey.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: 2,241	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	2,241	2,241
Annual IC Time Burden (Hours)	2,241	2,241
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.