OAHM Client Impact Evaluation Interview (Baseline)

Evaluation of the Older Adults Home Modification Grant Program

Documents and Forms

Document Name Document Type
Appendix F. Client Impact Evaluation Interview Form_OAHM_Final.docx Other-OAHM Client Impact Evaluation
Appendix F. Client Impact Evaluation Interview Form_OAHM_Final.docx Other-OAHM Client Impact Evaluation
Appendix F. Client Impact Evaluation Interview Form_OAHM_FINAL_SPL.docx Other-OAHM Client Impact Evaluation
Appendix F. Client Impact Evaluation Interview Form_OAHM_FINAL_SPL.docx Other-OAHM Client Impact Evaluation
Appendix F. Client Impact Evaluation Interview_EOAHMP-C2.DRAFT (clean).docx Other-Appendix F. Client Impact Eval
Appendix F. Client Impact Evaluation Interview_EOAHMP-C2.DRAFT (clean).docx Other-Appendix F. Client Impact Eval
REV.Client Impact Evaluation Interview_EOAHMP-C2(Baseline and Post).(CLEAN).docx Other-Revised Client Impact Evaluati
REV.Client Impact Evaluation Interview_EOAHMP-C2(Baseline and Post).(CLEAN).docx Other-Revised Client Impact Evaluati

Information Collection (IC) Details

IC Title:	OAHM Client Impact Evaluation Interview (Baseline)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-OAHM Client Impact Evaluation Interview (Baseline)	Appendix F. Client Impact Evaluation Interview Form_OAHM_Final.docx	No	Paper Only
Other-OAHM Client Impact Evaluation Interview (Baseline)	Appendix F. Client Impact Evaluation Interview Form_OAHM_FINAL_SPL.docx	No	Paper Only
Other-Appendix F. Client Impact Evaluation Interview_EOAHMP-C2.DRAFT (clean)	Appendix F. Client Impact Evaluation Interview_EOAHMP-C2.DRAFT (clean).docx	No	Paper Only
Other-Revised Client Impact Evaluation Interview	REV.Client Impact Evaluation Interview_EOAHMP-C2(Baseline and Post).(CLEAN).docx	No	Paper Only

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,250	2,250
Annual IC Time Burden (Hours)	743	743
Annual IC Cost Burden (Dollars)	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.