Client Eligibility Documentation Form

Evaluation of the Older Adults Home Modification Grant Program

Documents and Forms

Document Name Document Type
Appendix B. Client Eligibility Documentation Form_OAHM_Final.docx Other-Client Eligibility Documentati
Appendix B. Client Eligibility Documentation Form_OAHM_Final.docx Other-Client Eligibility Documentati
Appendix B. Client Eligibility _EOAHMP-C2.DRAFT (clean).docx Other-Appendix B. Client Eligibility
Appendix B. Client Eligibility _EOAHMP-C2.DRAFT (clean).docx Other-Appendix B. Client Eligibility

Information Collection (IC) Details

IC Title:	Client Eligibility Documentation Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Client Eligibility Documentation Form			Appendix B. Client Eligibility Documentation Form_OAHM_Final.docx		No		Paper Only
Other-Appendix B. Client Eligibility _EOAHMP-C2.DRAFT (clean)			Appendix B. Client Eligibility _EOAHMP-C2.DRAFT (clean).docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,478	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	4,478	4,478
Annual IC Time Burden (Hours)	358	358
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.