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Initial Questionnaire
Evaluation of the Supportive Services Demonstration
OMB: 2528-0321
IC ID: 232275
OMB.report
HUD/PD&R
OMB 2528-0321
ICR 202005-2528-001
IC 232275
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2528-0321 can be found here:
2023-10-25 - No material or nonsubstantive change to a currently approved collection
2023-03-30 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
SSDE Supporting Statement Appendix A 06-20-18.docx
Other-Initial Questionnaire for Trea
SSDE Supporting Statement Appendix B 06-20-18.docx
Other-Initial Questionnaire for Acti
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Initial Questionnaire
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Removed
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-Initial Questionnaire for Treatment Properties
SSDE Supporting Statement Appendix A 06-20-18.docx
No
Paper Only
Other-Initial Questionnaire for Active Control Properties with a Service Coordinator
SSDE Supporting Statement Appendix B 06-20-18.docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Community and Regional Development
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
120
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
0
0
-120
0
0
120
Annual IC Time Burden (Hours)
0
0
-180
0
0
180
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.