Mobility Services Providers Interview Guide

The Community Choice Demonstration

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Revised - Instrument 4 Mobility Services Provider Interview Guide.docx Other- Revised - Instrument 4 Mobili
Revised - Instrument 4 Mobility Services Provider Interview Guide.docx Other- Revised - Instrument 4 Mobili

Information Collection (IC) Details

IC Title:	MOBILITY SERVICES PROVIDERS INTERVIEW GUIDE	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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- Revised - Instrument 4 Mobility Services Provider Interview Guide			Revised - Instrument 4 Mobility Services Provider Interview Guide.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 45	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-45	45
Annual IC Time Burden (Hours)	-68	68
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.