Information Collection

DCS 4: SAQ Program Participant Pre-Test

IC 215791 under ICR 201807-0970-003 · OMB 0970-0460.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument DCS-4RF_1_Pre-Test For Community Fathers.docx	Other-Pre-test RF Comm Fathers
Instrument DCS-4HM_3_Pre-Test For Youth.docx	Other-Pre-test Youth
Instrument DCS-4HM_1_Pre-Test For Adults_UpdatedSkips_20180629.docx	Other-Pre-test HM Adults
Instrument DCS-4RF_3_Pre_Test For Incarcerated Fathers_UpdatedSkips_20180629.docx	Other-Pre-test RF Inc Fathers

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Pre-test RF Comm Fathers	Instrument DCS-4RF_1_Pre-Test For Community Fathers.docx	Yes	Yes	Fillable Fileable
Other-Pre-test Youth	Instrument DCS-4HM_3_Pre-Test For Youth.docx	Yes	Yes	Fillable Fileable
Other-Pre-test HM Adults	Instrument DCS-4HM_1_Pre-Test For Adults_UpdatedSkips_20180629.docx	Yes	Yes	Fillable Fileable
Other-Pre-test RF Inc Fathers	Instrument DCS-4RF_3_Pre_Test For Incarcerated Fathers_UpdatedSkips_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: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	79,831	-31,844	111,675
Annual IC Time Burden (Hours)	33,529	-13,375	46,904
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.