Case Enrollment Data

Regional Partnership Grants National Cross-Site Evaluation and Evaluation Technical Assistance

Documents and Forms

Document Name Document Type
Form 1 Case Enrollment Data Form and Instruction
1 Enrollment and Service Log Data Dictionary III Enrollment and Service Log Data Dictionary.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Case Enrollment Data	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Enrollment and Service Log Data Dictionary	III Enrollment and Service Log Data Dictionary.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: 63	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,670	5,670
Annual IC Time Burden (Hours)	1,418	1,418
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.