Enrollment and services data: Case closure – prenatal (Appendix F)

CB Evaluation: Regional Partnership Grants (RPG) National Cross-Site Evaluation and Evaluation Technical Assistance [Implementation/descriptive study and Outcomes/Impact analyses]

Documents and Forms

Document Name Document Type
Appendix F_Enrollment and Services_Data Elements_CLEAN.pdf Other-Data Elements
Appendix F_Enrollment and Services_Data Elements_CLEAN.pdf Other-Data Elements

Information Collection (IC) Details

IC Title:	Enrollment and services data: Case closure – prenatal (Appendix F)	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-Data Elements			Appendix F_Enrollment and Services_Data Elements_CLEAN.pdf		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: 36	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	360	180	180
Annual IC Time Burden (Hours)	6	3	3
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.