OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Staff, Administrators, Supervisors, Providers, Social Workers

IC 219841 under ICR 201601-0930-003 · OMB 0930-0359.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Staff, Administrators, Supervisors, Providers, Social Workers
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Performance Site Survey Performance Site Survey Attachment 1 - Performance site survey_10-20-15.docx Yes Yes Fillable Fileable

Health Health Care Services

 

1,407 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,407 0 1,407 0 0 0
Annual IC Time Burden (Hours) 310 0 310 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Network Security at RTI Attachment 2- Network security at RTI_10-20-15.doc 01/27/2016
Privacy Pledge Attachment 3 - Privacy pledge.doc 01/27/2016
Consent Attachment 4 - Performance site survey consent script.doc 01/27/2016
Table Shells Attachment 5 - Table shells for descriptive results.doc 01/27/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.