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Background Information Form (Previously titled Young Adult Baseline Survey)
Transition Living Program Evaluation
OMB: 0970-0383
IC ID: 189105
OMB.report
HHS/ACF
OMB 0970-0383
ICR 202007-0970-013
IC 189105
( )
Documents and Forms
Document Name
Document Type
C_Young Adult Background Information Form_071620_clean_for OMB.docx
Other-Survey
Memo_TLP YOS_NonSub Change Request_final_071620.docx
Memo - NonSub Change - COVID-19
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Background Information Form (Previously titled Young Adult Baseline Survey)
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
Other-Survey
C_Young Adult Background Information Form_071620_clean_for OMB.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Social Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
400
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
400
0
200
0
0
200
Annual IC Time Burden (Hours)
112
0
-12
0
0
124
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Memo - NonSub Change - COVID-19
Memo_TLP YOS_NonSub Change Request_final_071620.docx
07/24/2020
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.