Information Collection

NAC Survey

IC 243839 under ICR 202110-0970-002 · OMB 0970-0560.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Revised NAC Survey_Clean_1.29.21.docx	Other-NAC Survey
Revised NAC Survey_Clean_1.29.21.docx	Other-NAC Survey
NAC Sample State Response_1.29.21.docx NAC Sample State Response	IC Document
NAC Sample State Response_1.29.21.docx NAC Sample State Response	IC Document

IC Title:

NAC Survey

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-NAC Survey			Revised NAC Survey_Clean_1.29.21.docx		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: 250

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	3,713	3,713
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NAC Sample State Response	NAC Sample State Response_1.29.21.docx	02/02/2021

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