Information Collection

Pre-testing Request for Strengthening Relationship Education and Marriage Services (STREAMS)

IC 232972 under ICR 201802-0970-003 · OMB 0970-0355.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0355 can be found here:

Documents and Forms

Document Name Document Type
Instrument 1_Facilitator Self Assessment Form_8-23-18.docx Other-Facilitator Self Assessment
STREAMS generic pretesting OMB SSA_8-23-18.docx STREAMS generic pretesting OMB SSA_8-23-18 IC Document
STREAMS generic prestesting OMB SSB_8-23-18.docx STREAMS generic prestesting OMB SSB_8-23-18 IC Document
Attachment A_STREAMS_Legislative authority.pdf Attachment A_STREAMS_Legislative authority IC Document
Attachment B_STREAMS confidentiality pledge.pdf Attachment B_STREAMS confidentiality pledge IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Pre-testing Request for Strengthening Relationship Education and Marriage Services (STREAMS)	Agency IC Tracking Number:

IC Status: New

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
Other-Facilitator Self Assessment			Instrument 1_Facilitator Self Assessment Form_8-23-18.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 16	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	864	864
Annual IC Time Burden (Hours)	173	173
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
STREAMS generic pretesting OMB SSA_8-23-18	STREAMS generic pretesting OMB SSA_8-23-18.docx	09/11/2018
STREAMS generic prestesting OMB SSB_8-23-18	STREAMS generic prestesting OMB SSB_8-23-18.docx	09/11/2018
Attachment A_STREAMS_Legislative authority	Attachment A_STREAMS_Legislative authority.pdf	09/11/2018
Attachment B_STREAMS confidentiality pledge	Attachment B_STREAMS confidentiality pledge.pdf	09/11/2018

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