Information Collection

OAS-TA State Systems Specialist Network Feedback

IC 226904 under ICR 201705-0970-010 · OMB 0970-0401.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0401 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 OAS-TA State Systems Specialist Network Feedback	Form and Instruction
1 TA State Systems Network Feedback OCC OMB GC Request - SCBC Task 4 State TA - April 2017 Tool.docx	Form and Instruction
OCC OMB GC Request - SCBC Task 4 State TA - April 2017.docx State Systems Specialist Network Feedback	IC Document

IC Title:

OAS-TA State Systems Specialist Network Feedback

Agency IC Tracking Number:

IC Status: Unchanged

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	TA State Systems Network Feedback	OCC OMB GC Request - SCBC Task 4 State TA - April 2017 Tool.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: 40

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	40	40
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
State Systems Specialist Network Feedback	OCC OMB GC Request - SCBC Task 4 State TA - April 2017.docx	05/17/2017

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