Site Assessment Form for Homeless Service Sites

Homeless Service Providers’ Knowledge, Attitudes, and Practices Regarding Body Lice, Fleas and Associated Diseases

Documents and Forms

Document Name Document Type
Site Assessment Form for Homeless Service Sites Form and Instruction
Site Assessment Form - Homeless Service Sites Att_6_Site_Assessment_Shelter.docx Form and Instruction
Site Assessment Form - Homeless Service Sites Att_6_Site_Assessment_Shelter.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Site Assessment Form for Homeless Service Sites	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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
Form and Instruction	NA	Site Assessment Form - Homeless Service Sites	Att_6_Site_Assessment_Shelter.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Previously Approved
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	10	10
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.