SHIP-SMP Survey of One-on-One Assistance

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0985-0057 can be found here:

Documents and Forms

Document Name Document Type
SHIP-SMP Survey of One-on-One Assistance Form and Instruction
SHIP-SMP Survey of One-on-One Assistance 0057 1 on 1 Assistance Survey Final.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SHIP-SMP Survey of One-on-One Assistance	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Form and Instruction	NA	SHIP-SMP Survey of One-on-One Assistance	0057 1 on 1 Assistance Survey Final.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: 800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	800	0	-550	1,350
Annual IC Time Burden (Hours)	80	-100	0	180
Annual IC Cost Burden (Dollars)	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.