Information Collection

Fasd - Cfe - Sbi - Choices

IC 189113 under ICR 201310-0930-001 · OMB 0930-0302.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FormB_SBI_Process FASD - CFE - SBI - CHOICES	Form and Instruction
FormB_SBI_Process FormB_SBI_Process FormB_SBI_Process_7-2-13.doc	Form and Instruction
FormA_Assessment_T FormA_Assessment_Tool FormA_Assessment_Tool_7-2-13.doc	Form and Instruction
FormC_Client_Satis FormC_Client_Satisfaction FormC_Client_Satisfaction_7-2-13.doc	Form and Instruction

IC Title:

FASD - CFE - SBI - CHOICES

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FormB_SBI_Process	FormB_SBI_Process	FormB_SBI_Process_7-2-13.doc	Yes	Yes	Fillable Printable
Form and Instruction	FormA_Assessment_Tool	FormA_Assessment_Tool	FormA_Assessment_Tool_7-2-13.doc	Yes	Yes	Fillable Printable
Form and Instruction	FormC_Client_Satisfaction	FormC_Client_Satisfaction	FormC_Client_Satisfaction_7-2-13.doc	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,493

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
	Requested	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	18,000	2	17,998
Annual IC Time Burden (Hours)	4,176	405	3,771
Annual IC Cost Burden (Dollars)	0	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.