Information Collection

New Instruments 5, 6, 12: First Follow-Up Surveys

IC 207454 under ICR 201607-0970-008 · OMB 0970-0398.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0398 can be found here:

Documents and Forms

Document Name Document Type
New Instrument # 5 - Master Follow-Up Survey.docx Other-Survey
New Instrument #6 - HFSA Follow-Up Survey.docx Other-Survey
PREP NY Follow-up Survey.12.23.13_clean.docx Other-Survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	New Instruments 5, 6, 12: First Follow-Up Surveys	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey	New Instrument # 5 - Master Follow-Up Survey.docx	Yes	Yes	Fillable Fileable
Other-Survey	New Instrument #6 - HFSA Follow-Up Survey.docx	Yes	Yes	Fillable Fileable
Other-Survey	PREP NY Follow-up Survey.12.23.13_clean.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: 1,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,600	1,600
Annual IC Time Burden (Hours)	1,200	1,200
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.