Information Collection

Appendix G: Guide for Implementation Study for Referral Provider Administrators

IC 232048 under ICR 202106-0970-005 · OMB 0970-0514.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0514 can be found here:

Documents and Forms

Document Name Document Type
Appendix G-Guide for Imp Study for Referral Provider Administrator_CLEAN.docx Other-Implementation Study Guide
Appendix G-Guide for Imp Study for Referral Provider Administrator_CLEAN.docx Other-Implementation Study Guide

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Appendix G: Guide for Implementation Study for Referral Provider Administrators	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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-Implementation Study Guide			Appendix G-Guide for Imp Study for Referral Provider Administrator_CLEAN.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: 5	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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	5	5
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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