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Federal forms, ICRs, and supporting documents

Information Collection

Client Questionnaire - baseline

IC 228977 under ICR 202012-0920-014 · OMB 0920-1218.

Documents and Forms
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Document Type
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Form
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Information Collection (IC) Details

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Client Questionnaire - baseline
 
No Removed
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Client questionnaire - baseline - Spanish Attachment 6 Client Questionnaire baseline 12 24 months__09_27_17_spanish.docx Yes Yes Fillable Fileable
Form none Client questionnaire - baseline English Attachment 6 Client Questionnaire baseline 12 24 months_9_27_17 17ACE_MAT.docx Yes Yes Fillable Fileable

Health Health Care Services

Epidemiologic Studies and Surveillance of Disease Problems  57 FR 62812

1,187 0
   
Individuals or Households
 
   100 %

  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 0 0 0 -1,187 0 1,187
Annual IC Time Burden (Hours) 0 0 0 -1,029 0 1,029
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.