IDCM Intake Assessment

Immediate Disaster Case Management Intake Assessment

OMB: 0970-0461

IC ID: 216998

Information Collection (IC) Details

View Information Collection (IC)

IDCM Intake Assessment OHSEPR
 
No Removed
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Senior Services Assessment Senior Services Assessment.pdf No   Printable Only
Form and Instruction 1 Access to Behavioral Health Assessment Access to Behavioral Health Assessment.pdf No   Printable Only
Form and Instruction 1 Child and Youth Services Assissement Child and Youth Services Assessment.pdf No   Printable Only
Form and Instruction 1 Client Intake Demographic Information Client Intake Demographic Informaton.pdf No   Printable Only
Form and Instruction 1 Clothing Assessment Clothing Assessment.pdf No   Printable Only
Form and Instruction 1 Family Financial Evaluation Family Financial Evaluation.pdf No   Printable Only
Form and Instruction 1 Food Assessment Food Assessment.pdf No   Printable Only
Form and Instruction 1 Furniture and Appliances Assessment Furniture and Appliances Assessment.pdf No   Printable Only
Form and Instruction 1 Health Insurance and Access to Health Care Health Insurance and Access to Health Care.pdf No   Printable Only
Form and Instruction 1 Housing Assessment Housing Assessment.pdf No   Printable Only
Form and Instruction 1 Lanaguage Assessment Language Assessment.pdf No   Printable Only
Form and Instruction 1 Legal Referral Services Legal Referral Services.pdf No   Printable Only
Form and Instruction 1 Post-Disaster Financial Assessment Post-Disaster Financial Assessment.pdf No   Printable Only
Form and Instruction 1 Pre-Disaster Financial Assessment Pre-Disaster Financial Assessment.pdf No   Printable Only
Form and Instruction 1 Transportation Assessment Transportation Assessment.pdf No   Printable Only

Community and Social Services Social Services

 

3,500 0
   
Individuals or Households
 
   0 %

  Approved 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 0 0 -3,500 0 0 3,500
Annual IC Time Burden (Hours) 0 0 -2,333 0 0 2,333
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Client Consent Client Consent To The Release of Confidential Information.docx 09/02/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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