Baseline Survey

Personal Responsibility Education Program (PREP) Multi-Component Evaluation

Documents and Forms

Document Name Document Type
PREP Eval - PAS+Baseline - Instrument 6 - HFSA baseline - Clean - 2-28-13.pdf Other-Survey
PREP Eval - PAS+B - Instrument 6 - Master baseline - Clean - 2-28-13.pdf Other-Survey
PREP NY Baseline Survey_clean.docx Other-Survey

Information Collection (IC) Details

IC Title:	Baseline Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey	PREP Eval - PAS+Baseline - Instrument 6 - HFSA baseline - Clean - 2-28-13.pdf	Yes	Yes	Fillable Fileable
Other-Survey	PREP Eval - PAS+B - Instrument 6 - Master baseline - Clean - 2-28-13.pdf	Yes	Yes	Fillable Fileable
Other-Survey	PREP NY Baseline Survey_clean.docx	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,900	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-1,900	1,900
Annual IC Time Burden (Hours)	-1,425	1,425
Annual IC Cost Burden (Dollars)	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.