View Information Collection (IC)

View Information Collection (IC)

IC Title:	Independent Living Facility Screener for American Housing Survey	Agency IC Tracking Number:

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
Form	AHS-101AR	Age Restricted Living Screener Questionnaire (American Housing Survey)	ahs101ar_12-29-08 Draft.pdf		No		Paper Only
Other-Privacy Statement			privacy statement.wpd		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 24	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	24	0	0	0	0	0
Annual IC Time Burden (Hours)	2	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
AHS Independent Living Facility Screener -- Plan	AL09_Screening_Notification 1-13-09. wpd.wpd	01/16/2009

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