View Information Collection (IC)

View Information Collection (IC)

IC Title:	8 & 9 - Baseline surveys	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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-Baseline Survey			9 - Baseline Survey for Sites Testing Employment Intervention.docx		Yes	Yes	Fillable Fileable
Other-Survey			8 - Baseline Survey for Sites Testing Parenting Intervention Revised 9-16-16_clean.docx		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: 947	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	947	0	0	0	0	947
Annual IC Time Burden (Hours)	608	0	0	0	0	608
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Baseline survey screen shots	9 - Baseline Survey for Sites Testing Employment Intervention - screen shots.docx	09/08/2016
Baseline survey Parent Intervention - Spanish Version	8 - Baseline Survey for Sites Testing Parenting Intervention Spanish 9-16-16.docx	09/30/2016

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