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Federal forms, ICRs, and supporting documents

Information Collection Request

Senior Commmunity Service Employment Program Needs Assessment Survey

ICR 199503-1205-002 · OMB 1205-0356 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
121412 Senior Commmunity Service Employment Program Needs Assessment Survey Migrated
ICR Details
1205-0356 199503-1205-002
Historical Active
DOL/ETA
Senior Commmunity Service Employment Program Needs Assessment Survey
New collection (Request for a new OMB Control Number)   No
Expedited
Approved without change 04/25/1995
Retrieve Notice of Action (NOA) 03/24/1995
Approved as amended by DOL's memoranda to OMB of 4/20/95 and 4/25/95. In addition, DOL has agreed to add to the cover letter and survey introduction the following phrase about maintaining confidentiality of responses, after "treated confidentially": "Your name will not be associated with your answers, and results will be reported based on the compiled answers of all people completing this questionnaire."
  Inventory as of this Action Requested Previously Approved
06/30/1995 06/30/1995
1 0 0
1,000 0 0
0 0 0
The proposed survey is a one-time request for information from 2,000 enrollees in the Senior Community Service Employment Program to determine their needs rather than substituting perceptions by either grantee or Federal staff.
None
None
No
1
IC Title Form No. Form Name
Senior Commmunity Service Employment Program Needs Assessment Survey
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1 0 0 1 0 0
Annual Time Burden (Hours) 1,000 0 0 1,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No
$0
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
03/24/1995