Information Collection

3. Follow-up home-based provider and assistant survey

IC 261154 under ICR 202408-0970-001 · OMB 0970-0615.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 3_Follow-up home-based provider and assistant survey_BASE_asst subset revised 12.21 clean.docx	Other-survey - assistant subset
Instrument 3_Follow-up home-based provider and assistant survey_BASE_asst subset revised 12.21 clean.docx	Other-survey - assistant subset
Instrument 3_Follow-up home-based provider and assistant survey_BASE_provider subset_revised 12.21 clean.docx	Other-survey - provider subset
Instrument 3_Follow-up home-based provider and assistant survey_BASE_provider subset_revised 12.21 clean.docx	Other-survey - provider subset
Instrument 3S Follow-up Home-Based Provider and Assistant Survey (Spanish version) FINAL.pdf	Other-Survey (Spanish)
Instrument 3S Follow-up Home-Based Provider and Assistant Survey (Spanish version) FINAL.pdf	Other-Survey (Spanish)

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-survey - assistant subset	Instrument 3_Follow-up home-based provider and assistant survey_BASE_asst subset revised 12.21 clean.docx	Yes	Yes	Fillable Fileable
Other-survey - provider subset	Instrument 3_Follow-up home-based provider and assistant survey_BASE_provider subset_revised 12.21 clean.docx	Yes	Yes	Fillable Fileable
Other-Survey (Spanish)	Instrument 3S Follow-up Home-Based Provider and Assistant Survey (Spanish version) FINAL.pdf	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, 09-80-0361

FR Citation: 87 FR 57198

Number of Respondents: 95

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	127	127
Annual IC Time Burden (Hours)	53	53
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.