OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Baseline information form for participants (Attachments D)

IC 235592 under ICR 202405-0970-001 · OMB 0970-0537.

Documents and Forms
Document Name
Document Type
Other-Standard BIF
Other-Standard BIF
Other-Tailored BIF - ARC Site
Other-Tailored BIF - ARC Site
Other-Tailored BIF - CCC Site
Other-Tailored BIF - CCC Site
Other-Tailored BIF - Franklin-Stark
Other-Tailored BIF - Franklin-Stark
Other-Tailored BIF - 2Gen-Chicago Si
Other-Tailored BIF - 2Gen-Chicago Si
Other-Tailored BIF - IPS FQHC site
Other-Tailored BIF - IPS FQHC site
Other-Tailored BIF - IPS SUD
Other-Tailored BIF - IPS SUD
Other-Tailored BIF - TANF-SNAP study
Other-Tailored BIF - TANF-SNAP study
Information Collection (IC) Details

View Information Collection (IC)

Baseline information form for participants (Attachments D)
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Standard BIF BEES_NonSub Change Request_Attachment D-Generic BIF CLEAN_Nov-Dec 2020.docx Yes Yes Fillable Fileable
Other-Tailored BIF - ARC Site Attachment D-1_BEES_BIF ARC_Clean.docx Yes Yes Fillable Fileable
Other-Tailored BIF - CCC Site Attachment D-2_BEES_BIF CCC_Clean.docx Yes Yes Fillable Fileable
Other-Tailored BIF - Franklin-Stark Site Attachment D-3_BEES_BIF Franklin-Stark_Clean.docx Yes Yes Fillable Fileable
Other-Tailored BIF - 2Gen-Chicago Site Attachment D-4_BEES_BIF 2Gen-Chicago_Clean.docx Yes Yes Fillable Fileable
Other-Tailored BIF - IPS FQHC site Attachment D-5_BEES_BIF IPS FQHC_Clean.docx Yes Yes Fillable Fileable
Other-Tailored BIF - IPS SUD Attachment D-1_BEES_IPS SUD BIF_May 2021_Clean.docx Yes Yes Fillable Fileable
Other-Tailored BIF - TANF-SNAP study BEES_NonSub Change Request_Attachment D-BIF-TANF-SNAP study.docx Yes Yes Fillable Fileable

Community and Social Services Social Services

 

1,000 0
   
Individuals or Households
 
   100 %

  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 1,000 0 0 0 0 1,000
Annual IC Time Burden (Hours) 250 0 0 0 0 250
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.