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Federal forms, ICRs, and supporting documents

Information Collection

Center-based provider QUESTIONNAIRE AND SCREENER

IC 232744 under ICR 201812-0970-006 · OMB 0970-0391.

Documents and Forms
Document Name
Document Type
Other-Questionnaire and Screener
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Center-based provider QUESTIONNAIRE AND SCREENER
 
No Modified
 
Voluntary
 

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 (clean copy).docx Yes Yes Fillable Fileable

Community and Social Services Social Services

 

7,800 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 7,800 0 0 0 0 7,800
Annual IC Time Burden (Hours) 5,850 0 0 0 0 5,850
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Revised Center-based Provider Screener and Questionnaire - Tracked Version - Nonsub Change Req Dec 2018 2_2019 NSECE Center-based Provider Screener and Questionnaire (tracking copy).docx 12/06/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.