Information Collection

Semi-annual progress reports - Private Sector

IC 209820 under ICR 201502-0970-009 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form IIA Semi-Annual Pr IIA Semi-Annual Progress Report Form Semi-annual progress reports - Private Sector	Form and Instruction
Form IIB Description of IIB Description of Evidence-Based Practices Semi-annual progress reports - Private Sector	Form and Instruction
Form IIC Description of IIC Description of Other Services and Activities Semi-annual progress reports - Private Sector	Form and Instruction
Form IID Description of IID Description of Partnerships Semi-annual progress reports - Private Sector	Form and Instruction
Form IIE Adherence Form IIE Adherence Form Semi-annual progress reports - Private Sector	Form and Instruction
IIA Semi-Annual Pr IIA Semi-Annual Progress Report Form IIA Semi-Annual Progress Report Form.pdf	Form and Instruction
IIB Description of IIB Description of Evidence-Based Practices IIB Description of Evidence-Based Practices.pdf	Form and Instruction
IIC Description of IIC Description of Other Services and Activities IIC Description of Other Services and Activities.pdf	Form and Instruction
IID Description of IID Description of Partnerships IID Description of Partnerships.pdf	Form and Instruction
IIE Adherence Form IIE Adherence Form IIE Adherence Form.pdf	Form and Instruction

IC Title:

Semi-annual progress reports - Private Sector

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	IIA Semi-Annual Progress Report Form	Yes	Yes	Fillable Printable
Form and Instruction	IIB Description of Evidence-Based Practices	Yes	Yes	Fillable Printable
Form and Instruction	IIC Description of Other Services and Activities	Yes	Yes	Fillable Printable
Form and Instruction	IID Description of Partnerships	Yes	Yes	Fillable Printable
Form and Instruction	IIE Adherence Form	Yes	Yes	Fillable Printable

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: 12

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	24	6	18
Annual IC Time Burden (Hours)	396	99	297
Annual IC Cost Burden (Dollars)	0	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.

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