Information Collection

Center-based provider QUESTIONNAIRE AND SCREENER

IC 232744 under ICR 201808-0970-002 · OMB 0970-0391.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0391 can be found here:

Documents and Forms

Document Name Document Type
2_2019 NSECE Center-based Provider Screener and Questionnaire.docx Other-Questionnaire and Screener

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Center-based provider QUESTIONNAIRE AND SCREENER	Agency IC Tracking Number:

Is this a Common Form? No		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-Questionnaire and Screener			2_2019 NSECE Center-based Provider Screener and Questionnaire.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: 7,800	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	7,800	7,800
Annual IC Time Burden (Hours)	5,850	5,850
Annual IC Cost Burden (Dollars)	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.