Information Collection

Baseline Survey

IC 249814 under ICR 202310-2528-003 · OMB 2528-0337.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2528-0337 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Revised - Instrument 2 HCV Mobility Evaluation Baseline Survey.docx	Other- Revised - Instrument 2 HCV Mo
Revised - Instrument 2 HCV Mobility Evaluation Baseline Survey.docx	Other- Revised - Instrument 2 HCV Mo

IC Title:

BASELINE SURVEY

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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- Revised - Instrument 2 HCV Mobility Evaluation Baseline Survey			Revised - Instrument 2 HCV Mobility Evaluation Baseline Survey.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-10,100	10,100
Annual IC Time Burden (Hours)	-7,575	7,575
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.