Information Collection

Continuu to Care Check-up Assessment Tool

IC 198834 under ICR 201108-2506-001 · OMB 2506-0191.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Check-up_welcome.pdf	Other-Screen Shots
CoC_Check_up_Overall_Flow_10182011-V2.pdf	Other-Screen Shots

IC Title:

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:

table that charts list of 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 %

table that charts list of burden
	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

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.