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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.