Information Collection

Collection Instruments - State & Local Agencies

IC 182700 under ICR 200711-0584-003 · OMB 0584-0547.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0547 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
State Level Survey.pdf	Other-Survey
State Level Interview.pdf	Other-Interview Guide
Local Level Survey.pdf	Other-Survey
Local Level Interview.pdf	Other-Interview Guide
Partner Organization Survey.pdf	Other-Survey
Advance Ltr to States.pdf	Other-Letter
Advance Ltr to Local Offices.pdf	Other-Letter
Partner Agency Interview.pdf	Other-Interview Guidelines

IC Title:

Collection Instruments - State & Local Agencies

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey	State Level Survey.pdf	Yes	Yes	Fillable Fileable
Other-Interview Guide	State Level Interview.pdf	No		Paper Only
Other-Survey	Local Level Survey.pdf	Yes	Yes	Fillable Fileable
Other-Interview Guide	Local Level Interview.pdf	No		Paper Only
Other-Survey	Partner Organization Survey.pdf	Yes	Yes	Fillable Fileable
Other-Letter	Advance Ltr to States.pdf	No		Paper Only
Other-Letter	Advance Ltr to Local Offices.pdf	No		Paper Only
Other-Interview Guidelines	Partner Agency Interview.pdf	No		Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 771

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 20 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	972	972
Annual IC Time Burden (Hours)	1,349	1,349
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.