Information Collection

Socess

IC 226022 under ICR 201703-0930-004 · OMB 0930-0375.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form System of Care Exp SOCESS	Form and Instruction
System of Care Exp System of Care Expansion and Sustainability Survey Attachment 3 System of Care Expansion and Sustainability Survey (SOCESS) 10-06-2016.docx	Form and Instruction

IC Title:

SOCESS

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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	System of Care Expansion and Sustainability Survey	System of Care Expansion and Sustainability Survey	Attachment 3 System of Care Expansion and Sustainability Survey (SOCESS) 10-06-2016.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,422

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,422	1,422
Annual IC Time Burden (Hours)	948	948
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.