Information Collection

Case enrollment data - Private Sector

IC 209822 under ICR 201612-0970-002 · OMB 0970-0444.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
III Enrollment and Service Log Data Dictionary_rev copy.pdf III Enrollment and Service Log Data Dictionary_rev copy	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation: 42 CFR B (To search for a specific CFR, visit the Code of Federal Regulations.)

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

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title: Records maintained on individuals

FR Citation: 5 FR 43

Number of Respondents: 36

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-1,080	1,080
Annual IC Time Burden (Hours)	-270	270
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
III Enrollment and Service Log Data Dictionary_rev copy	III Enrollment and Service Log Data Dictionary_rev copy.pdf	12/09/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.