Information Collection

Bundled Evaluation

IC 269085 under ICR 202503-3045-007 · OMB 3045-0202.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form PRBE Bundled Evaluation	Form and Instruction
Form PRBE Bundled Evaluation - Puerto Rico Bundled Evaluation	Form and Instruction
PRBE Bundled Evaluation - Puerto Rico 0202 - PR Bundle Instruments Combined_EDITED-Clean.docx	Form and Instruction
PRBE Bundled Evaluation - Puerto Rico 0202 - PR Bundle Instruments Combined_EDITED-Clean.docx	Form and Instruction

IC Title:

Bundled Evaluation

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	PRBE				Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 697

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	697	697
Annual IC Time Burden (Hours)	530	530
Annual IC Cost Burden (Dollars)	7,825	7,825

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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