Evaluation of Facilitation Services (Participant) - IC for Individual or Household Respondents

Program Evaluation Instruments - Collaborative Problem Solving Facilitation Services (Two Instruments)

Documents and Forms

Document Name Document Type
Form 3320-000N(1) Evaluation of Facilitation Services (Participant) - IC for Individual or Household Respondents Form and Instruction
3320-000N(1) Facilitation Services - Participant Questionnaire (Rev 2 Facilitation Services Participant Questionnaire (Rev2011).pdf Form and Instruction
3320 000N(1) Facilitation Services Participant Questionnaire Rev 2012 Facilitation Services Participant Questionnaire _Rev2012_.pdf Note: Electronic versions currently being finalized Form and Instruction

Information Collection (IC) Details

IC Title:	Evaluation of Facilitation Services (Participant) - IC for Individual or Household Respondents	Agency IC Tracking Number:	000Nd

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
Form and Instruction	3320-000N(1)	Facilitation Services - Participant Questionnaire (Rev 2011)	Facilitation Services Participant Questionnaire (Rev2011).pdf		Yes	Yes	Fillable Fileable
Form and Instruction	3320 000N(1)	Facilitation Services Participant Questionnaire Rev 2012	Facilitation Services Participant Questionnaire _Rev2012_.pdf	Note: Electronic versions currently being finalized	Yes	Yes	Fillable Fileable

Line of Business: Litigation and Judicial Activities

Subfunction: Resolution Facilitation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 310	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	310	-75	385
Annual IC Time Burden (Hours)	62	-66	128
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.