Information Collection

Staff Survey and Time Log

IC 243316 under ICR 202110-0970-006 · OMB 0970-0557.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Staff Survey and Time Log_Parent Child Interaction Therapy Version_clean.docx	Other-Staff Survey and Time Log: Par
Staff Survey and Time Log_Parent Child Interaction Therapy Version_clean.docx	Other-Staff Survey and Time Log: Par
Staff Survey and Time Log_Seeking Safety Version_clean.docx	Other-Staff Survey and Time Log: See
Staff Survey and Time Log_Seeking Safety Version_clean.docx	Other-Staff Survey and Time Log: See
Staff Survey and Time Log_Trauma Focused Cognitive Behavior Therapy_clean.docx	Other-Staff Survey and Time Log: Tra
Staff Survey and Time Log_Trauma Focused Cognitive Behavior Therapy_clean.docx	Other-Staff Survey and Time Log: Tra

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Staff Survey and Time Log: Parent Child Interaction Therapy Version	Yes	Yes	Fillable Fileable
Other-Staff Survey and Time Log: Seeking Safety Version	Yes	Yes	Fillable Fileable
Other-Staff Survey and Time Log: Trauma Focused Cognitive Behavior Therapy Version	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: 90

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	Previously Approved
Annual Number of Responses for this IC	90	90
Annual IC Time Burden (Hours)	330	330
Annual IC Cost Burden (Dollars)	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.

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