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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Pre-testing of Evaluation Surveys: An Examination of the Intersection of Domestic Human Trafficking with Child Welfare and Runaway and Homeless Youth Programs
Agency IC Tracking Number:
IC Status:
Unchanged
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-Screener
Appendix B. Cognitive Screener v3_Final Draft 102915.pdf
Yes
Yes
Fillable Fileable
Other-Survey
Appendix A. Survey Instrument Example Screenshots v3_Final Draft 102915.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Social Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
600
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
600
0
0
0
0
600
Annual IC Time Burden (Hours)
168
0
0
0
0
168
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Supporting Statement A: Pre-Testing Survey - Intersection of Domestic Human Trafficking with Child Welfare and Runaway and Homeless Youth Programs
Part A_v9_Final Draft 102915.docx
11/02/2015
Supporting Statement B: Pre-Testing Survey - Intersection of Domestic Human Trafficking with Child Welfare and Runaway and Homeless Youth Programs
Part B_v9_Final Draft 102915.docx
11/02/2015
Appendix C. Sources of Trafficking Questions
Appendix C. Sources of Trafficking Questions v2 Final Draft 102915.pdf
11/02/2015
Appendix D. Consent Forms
Appendix D. Consent Forms v3_Final Draft 102915.pdf
11/02/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.