Information Collection

Early Exit Interview

IC 264765 under ICR 202406-3045-001 · OMB 3045-0199.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3045-0199 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
05-Early Exit Interview.docx	Other-Interview Questions
05-Early Exit Interview.docx	Other-Interview Questions

IC Title:

Early Exit Interview

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

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-Interview Questions			05-Early Exit Interview.docx		No		Printable Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	237	237

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.