OAS-TA State Systems Specialist Network Feedback

Fast Track Generic Clearance for Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 1 OAS-TA State Systems Specialist Network Feedback Form and Instruction
1 TA State Systems Network Feedback OCC OMB GC Request - SCBC Task 4 State TA - April 2017 Tool.docx Form and Instruction
OCC OMB GC Request - SCBC Task 4 State TA - April 2017.docx State Systems Specialist Network Feedback IC Document

Information Collection (IC) Details

IC Title:	OAS-TA State Systems Specialist Network Feedback	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	TA State Systems Network Feedback	OCC OMB GC Request - SCBC Task 4 State TA - April 2017 Tool.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: 40	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
State Systems Specialist Network Feedback	OCC OMB GC Request - SCBC Task 4 State TA - April 2017.docx	05/17/2017

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