Information Collection

Prevention Services Data Collection

IC 236040 under ICR 201905-0970-003 · OMB 0970-0529.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0529 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Prevention Services Data Collection Form and Instruction
1 PSDC Elements FF Title IV-E Prevention Services Data Elements Technical Bulletin No. 1 05-14-2019.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Prevention Services Data Collection	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	PSDC Elements	FF Title IV-E Prevention Services Data Elements Technical Bulletin No. 1 05-14-2019.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: 20	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	1,240	1,240
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.