Information Collection

Center for States General Assessment for Tailored Services

IC 214915 under ICR 201211-0970-002 · OMB 0970-0401.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0401 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Center for States General Assessment for Tailored Services	Form and Instruction
1 Assessment Protocol Assessment Protocol Draft V11_for OMB 2-3-2015.docx	Form and Instruction
FastTrackOMBApplication_Tailoredservices General Assessment_2-2-15_for OMB.doc Center for States General Assessment for Tailored Services	IC Document

IC Title:

Center for States General Assessment for Tailored Services

Agency IC Tracking Number:

IC Status: New

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	1	Assessment Protocol	Assessment Protocol Draft V11_for OMB 2-3-2015.docx		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 260

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	260	260
Annual IC Time Burden (Hours)	1,664	1,664
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Center for States General Assessment for Tailored Services	FastTrackOMBApplication_Tailoredservices General Assessment_2-2-15_for OMB.doc	02/09/2015

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