Information Collection

Instrument 1: Descriptive Evaluation Final Report Template

IC 272758 under ICR 202412-0970-001 · OMB 0970-0640.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0640 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 1_Descriptive Evaluation Final Report Template.docx	Other-Report Template
Instrument 1_Descriptive Evaluation Final Report Template.docx	Other-Report Template

IC Title:

Instrument 1: Descriptive Evaluation Final Report Template

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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-Report Template					Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	2,000	2,000
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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].