Information Collection

Case Enrollment Data - Government

IC 209823 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
III Enrollment and Service Log Data Dictionary_rev copy.pdf III Enrollment and Service Log Data Dictionary_rev copy IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Case Enrollment Data - Government	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

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: 27	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	810	90	720
Annual IC Time Burden (Hours)	203	23	180
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
III Enrollment and Service Log Data Dictionary_rev copy	III Enrollment and Service Log Data Dictionary_rev copy.pdf	12/09/2013

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