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Patient Follow-up Survey for the Multi-site Evaluation of the Welfare-to-Work Grants Program
Patient Follow-up Survey for the Multi-site Evaluation of the Welfare-to-Work Grants Program
OMB: 0990-0238
IC ID: 10364
OMB.report
HHS/HHSDM
OMB 0990-0238
ICR 200306-0990-003
IC 10364
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Patient Follow-up Survey for the Multi-site Evaluation of the Welfare-to-Work Grants Program
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
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
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
4,164
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions
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
4,164
0
-8,586
0
0
12,750
Annual IC Time Burden (Hours)
9,819
0
0
0
0
9,819
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.