Information Collection

4: Entrance and Exit Surveys - Program clients (entrance)

IC 246006 under ICR 202212-0970-010 · OMB 0970-0566.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0566 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment_H_Instrument_4HM_1_Adult_EntranceSurvey.docx	Other-HM Adult Entrance Survey
Attachment_H_Instrument_4HM_1_Adult_EntranceSurvey.docx	Other-HM Adult Entrance Survey
Attachment_H_Instrument_4HM_3_Youth_EntranceSurvey_clean.docx	Other-HM Youth Entrance Survey
Attachment_H_Instrument_4HM_3_Youth_EntranceSurvey_clean.docx	Other-HM Youth Entrance Survey
Attachment_H_Instrument_4RF_1_CommunityFathers_EntranceSurvey_clean.docx	Other-RF Community Fathers Entrance
Attachment_H_Instrument_4RF_1_CommunityFathers_EntranceSurvey_clean.docx	Other-RF Community Fathers Entrance
Attachment_H_Instrument_4RF_3_CommunityMothers_EntranceSurvey_clean.docx	Other-RF Community Mothers Entrance
Attachment_H_Instrument_4RF_3_CommunityMothers_EntranceSurvey_clean.docx	Other-RF Community Mothers Entrance
Attachment_H_Instrument_4RF_5_ReenteringFathers_EntranceSurvey_clean.docx	Other-RF Reentering Fathers Entrance
Attachment_H_Instrument_4RF_5_ReenteringFathers_EntranceSurvey_clean.docx	Other-RF Reentering Fathers Entrance

IC Title:

4: Entrance and Exit Surveys - Program clients (entrance)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-HM Adult Entrance Survey	Attachment_H_Instrument_4HM_1_Adult_EntranceSurvey.docx	Yes	Yes	Fillable Fileable
Other-HM Youth Entrance Survey	Attachment_H_Instrument_4HM_3_Youth_EntranceSurvey_clean.docx	Yes	Yes	Fillable Fileable
Other-RF Community Fathers Entrance Survey	Attachment_H_Instrument_4RF_1_CommunityFathers_EntranceSurvey_clean.docx	Yes	Yes	Fillable Fileable
Other-RF Community Mothers Entrance Survey	Attachment_H_Instrument_4RF_3_CommunityMothers_EntranceSurvey_clean.docx	Yes	Yes	Fillable Fileable
Other-RF Reentering Fathers Entrance Survey	Attachment_H_Instrument_4RF_5_ReenteringFathers_EntranceSurvey_clean.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: 257,409

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	84,945	84,945
Annual IC Time Burden (Hours)	36,037	36,037
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.