1: Applicant Characteristics - Program Applicants

Healthy Marriage and Responsible Fatherhood Performance Measures and Additional Data Collection

Documents and Forms

Document Name Document Type
Attachment_E_Instrument_1_ApplicantCharacteristicsSurvey_clean.docx Other-Survey
Attachment_E_Instrument_1_ApplicantCharacteristicsSurvey_clean.docx Other-Survey

Information Collection (IC) Details

IC Title:	1: Applicant Characteristics - Program Applicants	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			Attachment_E_Instrument_1_ApplicantCharacteristicsSurvey_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	FR Citation: 87 FR 57198

Number of Respondents: 150,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	49,500	-40,867	90,367
Annual IC Time Burden (Hours)	12,500	-10,320	22,820
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.