Competency and CIDI Screener

Supported Employment Demonstration (SED) Project

Documents and Forms

Document Name Document Type
SED Attachments J3-K (05-03-2017).pdf Other-CIDI Screener
SED Attachment J2 (05-03-17).xlsx Other-Additional screener questions

Information Collection (IC) Details

IC Title:	Competency and CIDI Screener	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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-CIDI Screener			SED Attachments J3-K (05-03-2017).pdf		No		Paper Only
Other-Additional screener questions			SED Attachment J2 (05-03-17).xlsx		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,878	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,878	778	1,100
Annual IC Time Burden (Hours)	2,348	973	1,375
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.