Information Collection

Homelessness Survey

IC 260783 under ICR 202503-2900-010 · OMB 2900-0876.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0876 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Homelessness WF 6. Homelessness Survey	Form and Instruction
Form Homelessness WF 6. Homelessness WF 6.7.23 v3 Homelessness Survey	Form and Instruction
Homelessness WF 6. Homelessness WF 6.7.23 v3 Homelessness WF 6.7.23 v3.docx	Form and Instruction
Homelessness WF 6. Homelessness WF 6.7.23 v3 Homelessness WF 6.7.23 v3.docx	Form and Instruction
ICR Template_A11 Section 280 Clearance Homelessness v3.docx ICR Template_A11 Section 280 Clearance Homelessness v3	IC Document
ICR Template_A11 Section 280 Clearance Homelessness v3.docx ICR Template_A11 Section 280 Clearance Homelessness v3	IC Document

IC Title:

Homelessness Survey

Agency IC Tracking Number:

Homelessness Survey 2900-0876

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
Form and Instruction	Homelessness WF 6.7.23 v3				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Veterans, Dependents of Veterans, and Veteran Beneficiaries Survey Records

FR Citation: 86 FR 6992

Number of Respondents: 24,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	24,000	24,000
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
ICR Template_A11 Section 280 Clearance Homelessness v3		06/23/2023

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].