Information Collection

Regular AHS-Ineligible

IC 235270 under ICR 201810-2528-002 · OMB 2528-0017.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2528-0017 can be found here:

Documents and Forms

Document Name Document Type
AHS Computer Assisted Instrument (CAI) Items Booklet.pdf Other-Ineligible

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Regular AHS-Ineligible	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-Ineligible			AHS Computer Assisted Instrument (CAI) Items Booklet.pdf		Yes	Yes	Paper Only

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,398	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	3,398	-1,325	4,723
Annual IC Time Burden (Hours)	0	0	0
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.