Information Collection

Instrument 4: Guide for Implementation Study for Referral Provider Administrators

IC 232048 under ICR 202108-0970-015 · OMB 0970-0514.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 4 Guide for Implementation Study for Referral Provider Administrators.docx	Other-Implementation Study Guide
Instrument 4 Guide for Implementation Study for Referral Provider Administrators.docx	Other-Implementation Study Guide

IC Title:

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-Implementation Study Guide			Instrument 4 Guide for Implementation Study for Referral Provider Administrators.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: 2

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1	-4	5
Annual IC Time Burden (Hours)	1	-4	5
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.