Information Collection

12-Month Follow-Up Participant Interview (Attachment K)

IC 243385 under ICR 202405-0970-001 · OMB 0970-0537.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
K_12- to 18-Month Follow-Up Participant Survey_Phase 2_CLEAN.docx	Other-Participant Survey
K_12- to 18-Month Follow-Up Participant Survey_Phase 2_CLEAN.docx	Other-Participant Survey
K-1 12- to 24-month Follow-up Participant Survey.docx	Other-K-1: SUD Program Participant S
K-1 12- to 24-month Follow-up Participant Survey.docx	Other-K-1: SUD Program Participant S
K-2 BEES CCC Survey Instrument.docx	Other-Survey
K-2 BEES CCC Survey Instrument.docx	Other-Survey
K-3 12- to 24-Month Follow-Up Participant Survey.docx	Other-K-3 12- to 18-Month Follow-Up
K-3 12- to 24-Month Follow-Up Participant Survey.docx	Other-K-3 12- to 18-Month Follow-Up

IC Title:

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Participant Survey	K_12- to 18-Month Follow-Up Participant Survey_Phase 2_CLEAN.docx	No		Fillable Fileable
Other-K-1: SUD Program Participant Survey	K-1 12- to 24-month Follow-up Participant Survey.docx	Yes	Yes	Fillable Fileable
Other-Survey	K-2 BEES CCC Survey Instrument.docx	Yes	Yes	Fillable Fileable
Other-K-3 12- to 18-Month Follow-Up Participant Survey	K-3 12- to 24-Month Follow-Up Participant Survey.docx	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,433

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,433	1,433
Annual IC Time Burden (Hours)	717	717
Annual IC Cost Burden (Dollars)	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.