Information Collection

Annual Assessment Update (8 systematic questions)

IC 226795 under ICR 201705-0970-004 · OMB 0970-0501.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0501 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Annual Assessment Update (8 systematic questions)	Form and Instruction
1 Annual Assessment Update Annual Assessment Update - 8 systematic questions_2-10-17.docx	Form and Instruction

IC Title:

Annual Assessment Update (8 systematic questions)

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	1	Annual Assessment Update	Annual Assessment Update - 8 systematic questions_2-10-17.docx		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: 57

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	57	57
Annual IC Time Burden (Hours)	5	5
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.