Information Collection

NAC Survey

IC 243839 under ICR 202009-0970-018 · OMB 0970-0560.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0560 can be found here:

Documents and Forms

Document Name Document Type
NAC Survey_9.18.20.docx Other-NAC Survey
Revised NAC Survey_Clean_1.29.21.docx Other-NAC Survey
NAC Sample State Response_1.29.21.docx NAC Sample State Response IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NAC Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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-NAC Survey			Revised NAC Survey_Clean_1.29.21.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: 250	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	250	250
Annual IC Time Burden (Hours)	3,713	3,713
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
NAC Sample State Response	NAC Sample State Response_1.29.21.docx	02/02/2021

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