Recruitment Survey

Home Visiting Assessment of Implementation Quality Study: Understanding Supervisor Supports in Home Visiting

Documents and Forms

Document Name Document Type
Form 1 Recruitment Survey Form and Instruction
1 Recruitment Survey Appendix C Instrument 1 Recruitment Survey (08012024).docx Form and Instruction
1_redline Appendix C_Instrument 1 (Updated 12052024) Appendix C Instrument 1 Recruitment Survey 08012024_Approved_updatedBurdenStatement.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Recruitment Survey	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
Form and Instruction	1	Recruitment Survey	Appendix C Instrument 1 Recruitment Survey (08012024).docx		Yes	Yes	Fillable Fileable
Form and Instruction	1_redline	Appendix C_Instrument 1 (Updated 12052024)	Appendix C Instrument 1 Recruitment Survey 08012024_Approved_updatedBurdenStatement.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	Number of Respondents for Small Entity: 200

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	400	150	250
Annual IC Time Burden (Hours)	24	-19	43
Annual IC Cost Burden (Dollars)	0	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.