Information Collection

Participant 6-month Follow-up Survey

IC 219036 under ICR 201511-0970-004 · OMB 0970-0440.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0440 can be found here:

Documents and Forms

Document Name Document Type
JSA OMB - Attachment C - Six-Month Follow-Up Survey - 11.17.15.docx Other-Survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Participant 6-month Follow-up Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey			JSA OMB - Attachment C - Six-Month Follow-Up Survey - 11.17.15.docx		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: 3,200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,200	3,200
Annual IC Time Burden (Hours)	1,066	1,066
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.