Information Collection

OAHM Program Evaluation Informed Consent

IC 250817 under ICR 202411-2528-002 · OMB 2528-0335.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix E. Informed Consent Form_OAHM_Final.docx	Other-OAHM Program Evaluation Inform
Appendix E. Informed Consent Form_OAHM_Final.docx	Other-OAHM Program Evaluation Inform
Appendix E. Informed Consent Form_OAHM_FINAL_SPL.docx	Other-OAHM Program Evaluation Inform
Appendix E. Informed Consent Form_OAHM_FINAL_SPL.docx	Other-OAHM Program Evaluation Inform
Appendix E. Informed Consent_EOAHMP-C2.DRAFT(clean).docx	Other-Appendix E. Informed Consent_E
Appendix E. Informed Consent_EOAHMP-C2.DRAFT(clean).docx	Other-Appendix E. Informed Consent_E

IC Title:

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	Instrument File	Available Electronically?	Electronic Capability
Other-OAHM Program Evaluation Informed Consent	Appendix E. Informed Consent Form_OAHM_Final.docx	No	Paper Only
Other-OAHM Program Evaluation Informed Consent	Appendix E. Informed Consent Form_OAHM_FINAL_SPL.docx	No	Paper Only
Other-Appendix E. Informed Consent_EOAHMP-C2.DRAFT(clean)	Appendix E. Informed Consent_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: 2,250

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	2,250	2,250
Annual IC Time Burden (Hours)	563	563
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.