Information Collection

Participant Exit Survey (Instrument 2, all versions)

IC 223552 under ICR 202606-0970-012 · OMB 0970-0497.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 2a_Participant Exit Survey for high school and older youth - Final for OMB.docx	Other-Survey
Instrument 2b_Participant Exit Survey for middle school youth - Final for OMB.docx	Other-Survey

IC Title:

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
Other-Survey					Yes	Yes	Fillable Fileable
Other-Survey					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: 195,528

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	65,175	-41,558	106,733
Annual IC Time Burden (Hours)	5,429	-7,024	12,453
Annual IC Cost Burden (Dollars)	0	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.

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