Information Collection

Case Management Intake

IC 212081 under ICR 202109-0704-006 · OMB 0704-0528.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0528 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0704-0528_MOS-CMS Screenshots.pdf	Other-Screenshots
0704-0528_MOS-CMS Screenshots.pdf	Other-Screenshots
0704-0528_ADN_2.11.22.docx Agency Disclosure Notice	IC Document
0704-0528_ADN_2.11.22.docx Agency Disclosure Notice	IC Document

IC Title:

Case Management Intake

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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-Screenshots			0704-0528_MOS-CMS Screenshots.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 219,723

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	219,723	-5,861	225,584
Annual IC Time Burden (Hours)	219,723	163,327	56,396
Annual IC Cost Burden (Dollars)	397,699	-10,608	408,307

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Agency Disclosure Notice	0704-0528_ADN_2.11.22.docx	02/11/2022

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