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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Report Template			Instrument 1_Descriptive Evaluation Final Report Template.docx		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 %

	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

Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.