Information Collection

Instrument 5b: HPOG 2.0 National Evaluation letter and participant contact update form

IC 229938 under ICR 202212-0970-005 · OMB 0970-0462.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 5b_ HPOG 2 0 National Evaluation Contact Update Letter and Form_Rev07112017_clean.docx	Other-Update Form
Instrument 5b_ HPOG 2 0 National Evaluation Contact Update Letter and Form_Rev07112017_clean.docx	Other-Update Form
Instrument 5b_ HPOG2 Contact Update Form Phone Version.docx	Other-Update Form - Phone Version
Instrument 5b_ HPOG2 Contact Update Form Phone Version.docx	Other-Update Form - Phone Version

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Update Form			Instrument 5b_ HPOG 2 0 National Evaluation Contact Update Letter and Form_Rev07112017_clean.docx		Yes	Yes	Fillable Fileable
Other-Update Form - Phone Version			Instrument 5b_ HPOG2 Contact Update Form Phone Version.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,244

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	5,236	5,236
Annual IC Time Burden (Hours)	524	524
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.