Reach and Demographics

The Pregnancy Assistance Fund (PAF) Performance, FY2017-FY2019, revised for cohort 5

Documents and Forms

Document Name Document Type
Attachment E 0990_0460_Form_PAF PMs_Reach Demo_2017_2019_rev12212018_OMB_OAH42019_CLEAN.docx Other-survey instrument

Information Collection (IC) Details

IC Title:	Reach and Demographics	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-survey instrument			Attachment E 0990_0460_Form_PAF PMs_Reach Demo_2017_2019_rev12212018_OMB_OAH42019_CLEAN.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 23	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	23	4	19
Annual IC Time Burden (Hours)	244	42	202
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.