Information Collection

North Carolina Family Assessment Form

IC 198966 under ICR 201506-0930-003 · OMB 0930-0330.

Documents and Forms

Document Name Document Type
Form North Carolina Fam North Carolina Family Assessment Form Form and Instruction
North Carolina Fam North Carolina Family Assessment Form Attachment B- North Carolina Family Assessment Form-General + Reunificat .pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	North Carolina Family Assessment Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	North Carolina Family Assessment Form	North Carolina Family Assessment Form	Attachment B- North Carolina Family Assessment Form-General + Reunificat .pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 267	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	534	534
Annual IC Time Burden (Hours)	401	401
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.