DCS-3: Service Receipt in MIS

Fatherhood and Marriage Local Evaluation and Cross-Site Data Collection

Documents and Forms

Document Name Document Type
Instrument DCS-3_MIS Service Receipt_nFORM_screenshots_20180629.docx Other-MIS

Information Collection (IC) Details

IC Title:	DCS-3: Service Receipt in MIS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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-MIS			Instrument DCS-3_MIS Service Receipt_nFORM_screenshots_20180629.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: 79,831	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	Previously Approved
Annual Number of Responses for this IC	1,197,465	1,116,105	81,360
Annual IC Time Burden (Hours)	39,916	-764	40,680
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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