Continuu to Care Check-up Assessment Tool

Continuum of Care Check-up Assessment Tool

Documents and Forms

Document Name Document Type
Check-up_welcome.pdf Other-Screen Shots
CoC_Check_up_Overall_Flow_10182011-V2.pdf Other-Screen Shots

Information Collection (IC) Details

IC Title:	Continuu to Care Check-up Assessment Tool	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 24 CFR 583.1

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screen Shots			CoC_Check_up_Overall_Flow_10182011-V2.pdf		No		Fillable Printable
Other-Screen Shots			Check-up_welcome.pdf		No		Fillable Printable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 450	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,600	3,600
Annual IC Time Burden (Hours)	5,400	5,400
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.