PAIVED interview and site visit screener - REVISED 9.27.18

Preventing and Addressing Intimate Violence when Engaging Dads (PAIVED)

Documents and Forms

Document Name Document Type
Attachment 1 PAIVED Interview Site Visit Screener_5.10.18.docx Other-screener
PAIVED Interview Site Visit Screener_revised 9.27.18_CLEAN.docx Other-Interview Site Visit Screener

Information Collection (IC) Details

IC Title:	PAIVED interview and site visit screener - REVISED 9.27.18	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-screener			Attachment 1 PAIVED Interview Site Visit Screener_5.10.18.docx		Yes	Yes	Fillable Fileable
Other-Interview Site Visit Screener			PAIVED Interview Site Visit Screener_revised 9.27.18_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: 50	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	50	50
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.