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Instrument 5: Baseline survey - HM Study Participants
Parents and Children Together (PACT) Evaluation
OMB: 0970-0403
IC ID: 206001
OMB.report
HHS/ACF
OMB 0970-0403
ICR 201303-0970-001
IC 206001
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0403 can be found here:
2013-10-30 - Revision of a currently approved collection
2013-07-23 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
PACT Instrument (5) - Baseline Survey for Participants in Healthy Marria.docx
Other-Survey
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Instrument 5: Baseline survey - HM Study Participants
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
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
PACT Instrument (5) - Baseline Survey for Participants in Healthy Marria.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Social Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
4,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
4,000
0
4,000
0
0
0
Annual IC Time Burden (Hours)
2,000
0
2,000
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
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.