Follow-up Feedback Form

NHTTAC Consultant and Evaluation Package

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0519 can be found here:

Documents and Forms

Document Name Document Type
18 - Followup Feedback.pdf Other-null

Information Collection (IC) Details

IC Title:	Follow-up Feedback Form	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-null			18 - Followup Feedback.pdf		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: 500	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
Annual Number of Responses for this IC	500	203	297
Annual IC Time Burden (Hours)	67	27	40
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.