OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Home-based provider screener ([SCREENER ONLY] listed home-based providers)

IC 232740 under ICR 202010-0970-001 · OMB 0970-0391.

Documents and Forms
Document Name
Document Type
Other-Screener and Questionnaire
Other-SUMMER Screener & Questionnair
Information Collection (IC) Details

View Information Collection (IC)

Home-based provider screener ([SCREENER ONLY] listed home-based providers)
 
No Removed
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Screener and Questionnaire 4a_2019 NSECE Home-based Provider Screener and Questionnaire (clean copy).docx Yes Yes Fillable Fileable
Other-SUMMER Screener & Questionnaire 4a_2019 NSECE Home-based Provider Screener and Questionnaire (clean)_051419.docx Yes Yes Fillable Fileable

Community and Social Services Social Services

 

2,015 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 0 0 -2,015 0 2,015 0
Annual IC Time Burden (Hours) 0 0 -60 0 60 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.