OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Beneficiaries

IC 184626 under ICR 202403-0990-005 · OMB 0990-0330.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Appendix C1. Introductory Letter (English).docx Other-Introductory Letter English
Appendix C1. Introductory Letter (English).docx Other-Introductory Letter English
Appendix C2. Introductory Letter (Spanish).docx Other-Introductory Letter Spanish
Appendix C2. Introductory Letter (Spanish).docx Other-Introductory Letter Spanish
Appendix C3 Telephone Survey Introduction Script (English).docx Other-Telephone Introductory Script
Appendix C3 Telephone Survey Introduction Script (English).docx Other-Telephone Introductory Script
Appendix C4 Telephone Survey Introduction Script (Spanish).docx Other-Telephone Survey Script Spanis
Appendix C4 Telephone Survey Introduction Script (Spanish).docx Other-Telephone Survey Script Spanis
Appendix C5 Reminder Voicemail Script (English).docx Other-Reminder Voicemail Script Engl
Appendix C5 Reminder Voicemail Script (English).docx Other-Reminder Voicemail Script Engl
Appendix C6 Reminder Voicemail Script (Spanish).docx Other-Reminder Voicemail Script Span
Appendix C6 Reminder Voicemail Script (Spanish).docx Other-Reminder Voicemail Script Span
Appendix C7. Reminder Letter with Paper Questionnaire (English).docx Other-Reminder Letter English
Appendix C7. Reminder Letter with Paper Questionnaire (English).docx Other-Reminder Letter English
Appendix C8. Reminder Letter with Paper Questionnaire (Spanish).docx Other-Reminder Letter Spanish
Appendix C8. Reminder Letter with Paper Questionnaire (Spanish).docx Other-Reminder Letter Spanish
Appendix A1 Data Collector Confidentiality Agreement.docx Other-Confidentiality Agreement
Appendix A1 Data Collector Confidentiality Agreement.docx Other-Confidentiality Agreement
60-dayFederal Register, Volume 82 Issue 187 (Thursday, September 28, 2017).htm
60-day		IC Document
60-dayFederal Register, Volume 82 Issue 187 (Thursday, September 28, 2017).htm
60-day		IC Document
30-day Federal Register, Volume 82 Issue 247 (Wednesday, December 27, 2017).htm
30day		IC Document
30-day Federal Register, Volume 82 Issue 247 (Wednesday, December 27, 2017).htm
30day		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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-Introductory Letter English Appendix C1. Introductory Letter (English).docx Yes Yes Paper Only
Other-Introductory Letter Spanish Appendix C2. Introductory Letter (Spanish).docx Yes Yes Paper Only
Other-Telephone Introductory Script English Appendix C3 Telephone Survey Introduction Script (English).docx No   Paper Only
Other-Telephone Survey Script Spanish Appendix C4 Telephone Survey Introduction Script (Spanish).docx No   Paper Only
Other-Reminder Voicemail Script English Appendix C5 Reminder Voicemail Script (English).docx No   Paper Only
Other-Reminder Voicemail Script Spanish Appendix C6 Reminder Voicemail Script (Spanish).docx No   Paper Only
Other-Reminder Letter English Appendix C7. Reminder Letter with Paper Questionnaire (English).docx No   Fillable Fileable
Other-Reminder Letter Spanish Appendix C8. Reminder Letter with Paper Questionnaire (Spanish).docx No   Fillable Fileable
Other-Confidentiality Agreement Appendix A1 Data Collector Confidentiality Agreement.docx Yes Yes Paper Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 400 0 0 0 0 400
Annual IC Time Burden (Hours) 100 0 0 0 0 100
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
60-day 60-dayFederal Register, Volume 82 Issue 187 (Thursday, September 28, 2017).htm 01/26/2018
30day 30-day Federal Register, Volume 82 Issue 247 (Wednesday, December 27, 2017).htm 01/26/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.