Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Baseline Assessment Modified 75 75 1826 Form n/a
Other-Example Screen Shots of a Completed Baseline Assessment
Contact Information Unchanged 75 5 122 Form n/a
Eligibility Screening Modified 150 10 243 Form n/a
Follow-up Assessment Modified 150 150 3651 Form n/a
Other-Example Screen Shots of a Completed Follow-up Assessment
Participant Interview Unchanged 10 10 243 Form n/a
Staff Interview Unchanged 5 5 122 Form n/a
Total burden requested under this ICR: 465 255 6207  
To view an IC, click on IC Title