Information Collection Request

Immediate Disaster Case Management Intake Assessment

ICR 201806-0970-004 · OMB 0970-0461 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 IDCM Intake Assessment Form and Instruction Removed Available
SUPSTAT_HHS 11-2-18.docx Supporting Statement A Uploaded 2018-11-02 Available
Emer. Req. memo to OIRA 6-5-15.pdf Supplementary Document Uploaded 2015-06-23 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
231878 Case Session and information collection and assessments in English and Spanish, of Disaster Survivors immediate unmet needs New
216998 IDCM Intake Assessment Form and Instruction Removed

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
05/31/2020 36 Months From Approved 03/31/2018
630,000 0 3,500
630,000 0 2,333
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
IDCM Intake Assessment 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1 Senior Services Assessment ,   Access to Behavioral Health Assessment ,   Child and Youth Services Assissement ,   Client Intake Demographic Information ,   Clothing Assessment ,   Family Financial Evaluation ,   Food Assessment ,   Furniture and Appliances Assessment ,   Health Insurance and Access to Health Care ,   Housing Assessment ,   Lanaguage Assessment ,   Legal Referral Services ,   Post-Disaster Financial Assessment ,   Pre-Disaster Financial Assessment ,   Transportation Assessment
Case Session and information collection and assessments in English and Spanish, of Disaster Survivors immediate unmet needs 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 630,000 3,500 0 626,500 0 0
Annual Time Burden (Hours) 630,000 2,333 0 627,667 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No