Information Collection

Outcomes and impacts data - Standardized instruments: Enter data into local database (Appendix G)

IC 234667 under ICR 202302-0970-003 · OMB 0970-0527.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0527 can be found here:

Documents and Forms

Document Name Document Type
Appendix G_Standardized Instruments_Outcome and Impact Data_CLEAN.docx Other-Data Elements
Appendix G_Standardized Instruments_Outcome and Impact Data_CLEAN.docx Other-Data Elements

Information Collection (IC) Details

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IC Title:	Outcomes and impacts data - Standardized instruments: Enter data into local database (Appendix G)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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-Data Elements			Appendix G_Standardized Instruments_Outcome and Impact Data_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: 36	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,600	1,800	1,800
Annual IC Time Burden (Hours)	2,250	1,125	1,125
Annual IC Cost Burden (Dollars)	0	0	0

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.