Information Collection

3. Follow-up home-based provider and assistant survey

IC 261154 under ICR 202401-0970-009 · OMB 0970-0615.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0615 can be found here:

Documents and Forms

Document Name Document Type
Instrument 3_Follow-up home-based provider and assistant survey_BASE_asst subset revised 12.21 clean.docx Other-survey
Instrument 3_Follow-up home-based provider and assistant survey_BASE_asst subset revised 12.21 clean.docx Other-survey
Instrument 3_Follow-up home-based provider and assistant survey_BASE_provider subset_revised 12.21 clean.docx Other-survey
Instrument 3_Follow-up home-based provider and assistant survey_BASE_provider subset_revised 12.21 clean.docx Other-survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	3. Follow-up home-based provider and assistant survey	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-survey			Instrument 3_Follow-up home-based provider and assistant survey_BASE_asst subset revised 12.21 clean.docx		Yes	Yes	Fillable Fileable
Other-survey			Instrument 3_Follow-up home-based provider and assistant survey_BASE_provider subset_revised 12.21 clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title: OPRE Research and Evaluation Project Records, 09-80-0361	FR Citation: 87 FR 57198

Number of Respondents: 95	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: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	127	0	127
Annual IC Time Burden (Hours)	53	-42	95
Annual IC Cost Burden (Dollars)	0	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.