Information Collection

Baseline 05_Web Survey Treatment PHA 10.05.2022

IC 257552 under ICR 202411-2528-003 · OMB 2528-0340.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Final - 05_Baseline Web Survey Treatment PHA.docx	Other-Baseline 05_Web Survey Treatme
Final - 05_Baseline Web Survey Treatment PHA.docx	Other-Baseline 05_Web Survey Treatme

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Baseline 05_Web Survey Treatment PHA 10.05.2022					Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 140

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	46	46
Annual IC Time Burden (Hours)	23	23
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.

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