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Center for States - 2015
Fast Track Generic Clearance for Collection of Qualitative Feedback on Agency Service Delivery
OMB: 0970-0401
IC ID: 221111
OMB.report
HHS/ACF
OMB 0970-0401
ICR 201706-0970-005
IC 221111
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0401 can be found here:
2024-09-25 - No material or nonsubstantive change to a currently approved collection
2024-09-13 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 1
Center for States - 2015
Form and Instruction
1 Center for States Needs Assessment Survey 2016
Center for States Needs Assessment Survey 2016_4-15-2016_for OMB.docx
Form and Instruction
Center for States Needs Assessment Survey 2016 Fast Track OMB application_ for OMB.doc
Center for States Needs Assessment Survey
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Center for States - 2015
Agency IC Tracking Number:
IC Status:
Unchanged
Obligation to Respond:
Voluntary
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
Center for States Needs Assessment Survey 2016
Center for States Needs Assessment Survey 2016_4-15-2016_for OMB.docx
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Social Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
200
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
200
0
0
0
0
200
Annual IC Time Burden (Hours)
33
0
0
0
0
33
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Center for States Needs Assessment Survey
Center for States Needs Assessment Survey 2016 Fast Track OMB application_ for OMB.doc
04/18/2016
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.