Information Collection

Instrument 17: Follow-up protocol for child assessments (child burden)

IC 231367 under ICR 202104-0970-010 · OMB 0970-0508.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0508 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 17_CLEAN Follow-up Protocol for Child Assessments.docx	Other-Assessment Protocol
Instrument 17_CLEAN Follow-up Protocol for Child Assessments.docx	Other-Assessment Protocol

IC Title:

Instrument 17: Follow-up protocol for child assessments (child burden)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-Assessment Protocol			Instrument 17_CLEAN Follow-up Protocol for Child Assessments.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: 4,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,400	580	820
Annual IC Time Burden (Hours)	1,260	440	820
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.