Information Collection

SHIP-SMP Survey of One-on-One Assistance

IC 225703 under ICR 202306-0985-002 · OMB 0985-0057.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SHIP-SMP Survey of One-on-One Assistance	Form and Instruction
1-on-1 Assistance Survey 0057 1 on 1 Assistance Survey SOGI R_E.pdf	Form and Instruction
1-on-1 Assistance Survey 0057 1 on 1 Assistance Survey SOGI R_E.pdf	Form and Instruction

IC Title:

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	1-on-1 Assistance Survey	0057 1 on 1 Assistance Survey SOGI R_E.pdf		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: 800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	80	80
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.