Information Collection

Case enrollment data - Private Sector

IC 209822 under ICR 201312-0970-003 · OMB 0970-0444.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0444 can be found here:

Documents and Forms

Document Name Document Type
III Enrollment and Service Log Data Dictionary_rev copy.pdf III Enrollment and Service Log Data Dictionary_rev copy IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Case enrollment data - Private Sector	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR B (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title: Records maintained on individuals	FR Citation: 5 FR 43

Number of Respondents: 27	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	810	810
Annual IC Time Burden (Hours)	203	203
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
III Enrollment and Service Log Data Dictionary_rev copy	III Enrollment and Service Log Data Dictionary_rev copy.pdf	12/09/2013

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