Information Collection

Socea

IC 214513 under ICR 201501-0930-003 · OMB 0930-0349.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SOCEA SOCEA	Form and Instruction
SOCEA SOCEA Attachment 8 SOCEA protocols.docx	Form and Instruction
Attachment 1 Logic Model 12-17-14.docx Evaluation Logic Model	IC Document

IC Title:

SOCEA

Agency IC Tracking Number:

Is this a Common Form? No

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	SOCEA	SOCEA	Attachment 8 SOCEA protocols.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 858

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
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	858	858
Annual IC Time Burden (Hours)	1,063	1,063
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Evaluation Logic Model	Attachment 1 Logic Model 12-17-14.docx	01/08/2015

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