Information Collection

IDCM Intake Assessment

IC 216998 under ICR 201506-0970-007 · OMB 0970-0461.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0461 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 IDCM Intake Assessment	Form and Instruction
1 OHSEPR IDCM Intake Assessment ACF OHSEPR IDCM Intake Assessment.pdf	Form and Instruction

IC Title:

IDCM Intake Assessment

Agency IC Tracking Number:

OHSEPR

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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	1	OHSEPR IDCM Intake Assessment	ACF OHSEPR IDCM Intake Assessment.pdf		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,500	3,500
Annual IC Time Burden (Hours)	2,333	2,333
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.