Monthly Web-Based Time Survey

Evaluation of the HUD-DOJ Pay for Success Permanent Supportive Housing Demonstration

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2528-0319 can be found here:

Documents and Forms

Document Name Document Type
11-16-17 Appendix D.docx Other-Monthly Web-Based Time Survey

Information Collection (IC) Details

IC Title:	Monthly Web-Based Time Survey	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-Monthly Web-Based Time Survey			11-16-17 Appendix D.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 35	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	420	420
Annual IC Time Burden (Hours)	71	71
Annual IC Cost Burden (Dollars)	2,221	2,221

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.