3: Service Delivery Data

Healthy Marriage and Responsible Fatherhood Performance Measures and Additional Data Collection

Documents and Forms

Document Name Document Type
3_nFORM_ServiceReceipt.docx Other-Reporting System
3_nFORM_ServiceReceipt.docx Other-Reporting System

Information Collection (IC) Details

IC Title:	3: Service Delivery Data	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-Reporting System			3_nFORM_ServiceReceipt.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title: OPRE Research and Evaluation Project Records	FR Citation: 87 FR 57198

Number of Respondents: 1,650	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	47,300	-38,380	85,680
Annual IC Time Burden (Hours)	23,650	-19,190	42,840
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.