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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.