Information Collection

Direct Service Staff

IC 194044 under ICR 201010-0930-001 · OMB 0930-0317.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Direct Service Sta Direct Service Staff	Form and Instruction
Direct Service Sta Direct Service Staff Instruments Attachment 5-Direct Service Staff Instruments.pdf	Form and Instruction
Attachment 6-Direct Services Other.pdf Direct Service Staff Other	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Direct Service Staff Instruments	Direct Service Staff Instruments	Attachment 5-Direct Service Staff Instruments.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 144

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	288	288
Annual IC Time Burden (Hours)	288	288
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Direct Service Staff Other	Attachment 6-Direct Services Other.pdf	10/20/2010

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