Information Collection

Assessment and Service Delivery State Lead Interviews-Supplemental Questions

IC 226794 under ICR 202008-0970-004 · OMB 0970-0501.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0501 can be found here:

Documents and Forms

Document Name Document Type
TAB K_Assessment and Service Delivery State Lead Interview - Supplemental Questions.docx Other-Supplemental Questions

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Assessment and Service Delivery State Lead Interviews-Supplemental Questions	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-Supplemental Questions			TAB K_Assessment and Service Delivery State Lead Interview - Supplemental Questions.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	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	Previously Approved
Annual Number of Responses for this IC	30	-20	50
Annual IC Time Burden (Hours)	15	-10	25
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.