iCare Nuts and Bolts Post Class Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0036 can be found here:

Documents and Forms

Document Name Document Type
Form 0917-0036-09 iCare Nuts and Bolts Post Class Survey Form and Instruction
0917-0036-09 OMB Form No. 0917-0036-09, iCare Nuts and Bolts Post Cla OMB Form No. 0917-0036-09, iCare NutsAndBolts.pdf Form and Instruction
OMB Form No. 0917-0036-09, Mini-Supporting Statement.pdf Mini-Supporting Statemetn for OMB Form No. 0917-0036-09 IC Document

Information Collection (IC) Details

IC Title:	iCare Nuts and Bolts Post Class Survey	Agency IC Tracking Number:

IC Status: New

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
Form and Instruction	0917-0036-09	OMB Form No. 0917-0036-09, iCare Nuts and Bolts Post Class Survey	OMB Form No. 0917-0036-09, iCare NutsAndBolts.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 225	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	225	225
Annual IC Time Burden (Hours)	19	19
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Mini-Supporting Statemetn for OMB Form No. 0917-0036-09	OMB Form No. 0917-0036-09, Mini-Supporting Statement.pdf	07/11/2012

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