Information Collection

Baseline 05_Web Survey Treatment PHA 10.05.2022

IC 257552 under ICR 202206-2528-005 · OMB 2528-0340.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2528-0340 can be found here:

Documents and Forms

Document Name Document Type
Final - 05_Baseline Web Survey Treatment PHA.docx Other-Baseline 05_Web Survey Treatme
Final - 05_Baseline Web Survey Treatment PHA.docx Other-Baseline 05_Web Survey Treatme

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Baseline 05_Web Survey Treatment PHA 10.05.2022	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 05_Web Survey Treatment PHA 10.05.2022			Final - 05_Baseline Web Survey Treatment PHA.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 140	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	46	46
Annual IC Time Burden (Hours)	23	23
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.