Information Collection

Enrollment and services data: Service log entries (Appendix E)

IC 234663 under ICR 202105-0970-009 · OMB 0970-0527.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0527 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix E_Enrollment and Service Data Elements.pdf	Other-Data Elements
Appendix E_Enrollment and Service Data Elements.pdf	Other-Data Elements

IC Title:

Enrollment and services data: Service log entries (Appendix E)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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-Data Elements			Appendix E_Enrollment and Service Data Elements.pdf		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: 210

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	480,480	480,480
Annual IC Time Burden (Hours)	14,414	14,414
Annual IC Cost Burden (Dollars)	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.