Information Collection

DCS-3: Service Receipt in MIS

IC 215790 under ICR 201503-0970-007 · OMB 0970-0460.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0460 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument DCS-3 Service receipt wireframes 3-19-2015.pdf	Other-MIS

IC Title:

DCS-3: Service Receipt in MIS

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
Other-MIS			Instrument DCS-3 Service receipt wireframes 3-19-2015.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	81,360	81,360
Annual IC Time Burden (Hours)	40,680	40,680
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.