Information Collection

Foundational Assessment Survey

IC 224173 under ICR 201910-0970-010 · OMB 0970-0494.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
1a Foundational Assessment Survey-States_PRA.docx	Other-Survey - States
1b Foundational Assessment Survey-CIPs_PRA.docx	Other-Survey - CIPs
1c Foundational Assessment Survey- Tribes_PRA.docx	Other-Survey - Tribes

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-Survey - Tribes	1c Foundational Assessment Survey- Tribes_PRA.docx	Yes	Yes	Fillable Fileable
Other-Survey - States	1a Foundational Assessment Survey-States_PRA.docx	Yes	Yes	Fillable Fileable
Other-Survey - CIPs	1b Foundational Assessment Survey-CIPs_PRA.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: 277

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	277	277
Annual IC Time Burden (Hours)	28	28
Annual IC Cost Burden (Dollars)	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.