Information Collection

NCCC Successful Service Intervention Survey

IC 197671 under ICR 201102-3045-002 · OMB 3045-0138.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3045-0138 can be found here:

Documents and Forms

Document Name Document Type
Form 1 NCCC Successful Service Intervention Survey Form and Instruction
1 Successful Service Intervention Survey NCCC Successful Service FINAL 5.25.11.doc www.nationalservice.gov Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NCCC Successful Service Intervention Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 12501

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Successful Service Intervention Survey	NCCC Successful Service FINAL 5.25.11.doc	www.nationalservice.gov	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 660	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
Annual Number of Responses for this IC	660	660
Annual IC Time Burden (Hours)	88	88
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.