Information Collection

Service Log Entries - Government

IC 209825 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

IC Title:

Service Log Entries - Government

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:

table that charts list of 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: 48

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	37,440	37,440
Annual IC Time Burden (Hours)	1,872	1,872
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.