PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
POD Baseline Survey
Unchanged
16500
5500
0
Form and Instruction
N/A
Promoting Opportunity Demonstration (POD) Baseline Questionnaire
POD End of Year (EOYR) Form - Online
Removed
0
0
0
Form and Instruction
N/A
POD End of Year Reporting Form
POD End of Year Reporting (EOYR) Documentation
Modified
2615
349
0
Other-Letter and Instructions for Submission of Documentation
POD Informed Consent Form
Unchanged
16500
2750
0
Form
POD Informed Consent Form
Promoting Opportunity Demonstration (POD) Voluntary Participation Consent Form
Other-Letter to Recruited Respondents
Other-Informational Brochure
POD Monthly Earnings and Impairment-Related Work Expenses (IRWE) Reporting Form - Online
Unchanged
9360
780
0
Form
N/A
POD Monthly Earnings & IRWE Reporting Form
POD Monthly Earnings and Impairment-Related Work Expenses (IRWE) Reporting Form - Paper
Unchanged
21840
3640
0
Form and Instruction
N/A
POD Monthly Earnings & IRWE Reporting Form
POD Onsite Audit of Sample of Case Files in MIS
Unchanged
16
5
0
Other-Interview Topics and Assessment of Implementation Fidelity
POD Semi-Structured Interviews with Treatment Group Subjects
Unchanged
144
144
0
Other-Interview Topics
POD Staff Interviews with Site Staff
Unchanged
160
176
0
Other-Interview Topics and Explanation
POD Year 1 Follow-up Survey
Modified
6000
3200
0
Other-Follow-up Surveys
Other-Follow-up Survey Letters
POD Year 2 Follow-up Surveys
Modified
12000
5400
0
Other-Follow-up Surveys
Other-Follow-up Survey Letters
Total burden requested under this ICR:
85135
21944
0
To view an IC, click on IC Title
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