Information Collection

6. One-on-one home-based provider interview

IC 261157 under ICR 202402-0970-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Instrument 6_One-on-One Home-based Provider Interview_BASE_revised 12.19.2023_clean.docx	Other-interview
Instrument 6_One-on-One Home-based Provider Interview_BASE_revised 12.19.2023_clean.docx	Other-interview

IC Title:

6. One-on-one home-based provider interview

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
Other-interview			Instrument 6_One-on-One Home-based Provider Interview_BASE_revised 12.19.2023_clean.docx		Yes	Yes	Printable Only

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: 25

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	17	0	17
Annual IC Time Burden (Hours)	17	-8	25
Annual IC Cost Burden (Dollars)	0	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.