Site Visit Interview #1

Evaluation of the Jobs Plus Pilot Program

Documents and Forms

Document Name Document Type
Appendix A_Site Visit Interview Guide_Round 1_Revised 6_9.docx Other-Round 1 Site Visit Interview G

Information Collection (IC) Details

IC Title:	Site Visit Interview #1	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-Round 1 Site Visit Interview Guide			Appendix A_Site Visit Interview Guide_Round 1_Revised 6_9.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 108	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	108	108
Annual IC Time Burden (Hours)	162	162
Annual IC Cost Burden (Dollars)	215,334	215,334

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.