Information Collection Request

Intake/Interview & Quality Review Sheets

ICR 201603-1545-009 · OMB 1545-1964 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 13614-C Intake/Interview and Quality Review Sheet (English & 9 Translations) Form Modified Available
Form 13614-C (SP) Intake/Interview & Quality Review Sheet - Spanish Form Modified Available
ombat2.doc Supplementary Document Uploaded 2009-11-06 Available
1545-1964_supporting_statement_20160329.pdf Supporting Statement A Uploaded 2016-03-29 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
19697 Intake/Interview and Quality Review Sheet (English & 9 Translations) Form Modified
191233 Intake/Interview & Quality Review Sheet - Spanish Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/28/2017 6 Months From Approved 08/31/2016
3,700,000 0 3,375,000
616,803 0 562,583
0 0 0





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 3,700,000 3,375,000 0 0 325,000 0
Annual Time Burden (Hours) 616,803 562,583 0 0 54,220 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No