AFI Baseline Questionnaire: AFI-eligible participants

Assets for Independence (AFI) Program Evaluation

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0414 can be found here:

Documents and Forms

Document Name Document Type
AFI Baseline Questionnaire - 8.7.12 - revised.docx Other-Baseline Questionnaire

Information Collection (IC) Details

IC Title:	AFI Baseline Questionnaire: AFI-eligible participants	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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-Baseline Questionnaire			AFI Baseline Questionnaire - 8.7.12 - revised.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: 367	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	367	367
Annual IC Time Burden (Hours)	184	184
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.