#1 - Adult Survey Wave 1

Supporting Healthy Marriage (SHM) Demonstration and Evaluation Project - Wave 2 Survey

Documents and Forms

Document Name Document Type
#1 - Adult Survey Wave 1.doc Other-#1 - Adult Survey Wave 1

Information Collection (IC) Details

IC Title:	#1 - Adult Survey Wave 1	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-#1 - Adult Survey Wave 1			#1 - Adult Survey Wave 1.doc		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,267	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	4,267	-5,973	10,240
Annual IC Time Burden (Hours)	3,542	-4,991	8,533
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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