Information Collection

Child and Family Instruments

IC 214520 under ICR 201501-0930-003 · OMB 0930-0349.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Child and Family Child and Family Instruments	Form and Instruction
Child and Family Child and Family Attachment 9 Final Child and Family level tools 12-17-14.docx	Form and Instruction

IC Title:

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	Child and Family	Child and Family	Attachment 9 Final Child and Family level tools 12-17-14.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,083

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	50,322	50,322
Annual IC Time Burden (Hours)	5,959	5,959
Annual IC Cost Burden (Dollars)	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.