Information Collection

Partner Survey - Government

IC 209829 under ICR 201502-0970-009 · OMB 0970-0444.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0444 can be found here:

Documents and Forms

Document Name Document Type
Form VA Partner Survey Partner Survey - Government Form and Instruction
VA Partner Survey VA Partner Survey VA Partner Survey.pdf Form and Instruction
VB Partner Survey FAQ.pdf VB Partner Survey FAQ IC Document
VC Partner Survey Advance Email.pdf VC Partner Survey Advance Email IC Document
VD Partner Survey Email Invitation.pdf VD Partner Survey Email Invitation IC Document
VE Partner Survey Reminder Email.pdf VE Partner Survey Reminder Email IC Document
VF Partner Survey Final Reminder Email.pdf VF Partner Survey Final Reminder Email IC Document
VG Partner Survey Grantee Reminder Request.pdf VG Partner Survey Grantee Reminder Request IC Document
VH Partner Survey Thank-You Email.pdf VH Partner Survey Thank-You Email IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Partner Survey - Government	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR B (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	VA Partner Survey	VA Partner Survey	VA Partner Survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title: Records maintained on individuals	FR Citation: 5 FR 43

Number of Respondents: 180	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	59	-48	107
Annual IC Time Burden (Hours)	19	-16	35
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
VB Partner Survey FAQ	VB Partner Survey FAQ.pdf	12/09/2013
VC Partner Survey Advance Email	VC Partner Survey Advance Email.pdf	12/09/2013
VD Partner Survey Email Invitation	VD Partner Survey Email Invitation.pdf	12/09/2013
VE Partner Survey Reminder Email	VE Partner Survey Reminder Email.pdf	12/09/2013
VF Partner Survey Final Reminder Email	VF Partner Survey Final Reminder Email.pdf	12/09/2013
VG Partner Survey Grantee Reminder Request	VG Partner Survey Grantee Reminder Request.pdf	12/09/2013
VH Partner Survey Thank-You Email	VH Partner Survey Thank-You Email.pdf	12/09/2013

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