OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Site Assessment Form for Street/Outreach Workers

IC 255802 under ICR 202209-0920-024 · OMB 0920-1372.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Site Assessment Form for Street/Outreach Workers
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA Site Assessment Form - Street/Outreach Workers Att_7_Site_Assessment_Outreach.docx NA Yes Yes Fillable Fileable

Health Illness Prevention

 

40 0
   
Individuals or Households
 
   50 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 40 0 0 0 0 40
Annual IC Time Burden (Hours) 10 0 0 0 0 10
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.