Information Collection

North Carolina Family Assessment Form

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
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 %

table that charts list of burden
	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

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.