Child and Family Services Review Statewide Assessment

Title IV-E Foster Care Eligibility Reviews, Child and Family Services Reviews

Documents and Forms

Document Name Document Type
Form 1 Child and Family Services Review Statewide Assessment Form and Instruction
1 Statewide Assessment Attachment A - CFSR_SA_R4_4-2021 30 Day FRN.docx Form and Instruction
1 Statewide Assessment Attachment A - CFSR_SA_R4_4-2021 30 Day FRN.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Child and Family Services Review Statewide Assessment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 1355.33(b)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Statewide Assessment	Attachment A - CFSR_SA_R4_4-2021 30 Day FRN.docx		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 25 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	13	13
Annual IC Time Burden (Hours)	1,560	1,560
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.