Information Collection

Center for States - 2015

IC 221111 under ICR 201502-0970-004 · OMB 0970-0401.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0401 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Center for States - 2015	Form and Instruction
1 Center for States Needs Assessment Survey 2016 Center for States Needs Assessment Survey 2016_4-15-2016_for OMB.docx	Form and Instruction
Center for States Needs Assessment Survey 2016 Fast Track OMB application_ for OMB.doc Center for States Needs Assessment Survey	IC Document

IC Title:

Center for States - 2015

Agency IC Tracking Number:

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	1	Center for States Needs Assessment Survey 2016	Center for States Needs Assessment Survey 2016_4-15-2016_for OMB.docx		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

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	200	200
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Center for States Needs Assessment Survey	Center for States Needs Assessment Survey 2016 Fast Track OMB application_ for OMB.doc	04/18/2016

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