Information Collection

Long Term Foster Care Client Questionnaire (M-12C) - Respondents

IC 245616 under ICR 202112-0970-003 · OMB 0970-0564.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0564 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form M-12C Long Term Foster Care Client Questionnaire (M-12C) - Respondents	Form and Instruction
Form M-12C LTFC Client Questionnaire LTFC Client Questionnaire (Form M-12C).docx	Form and Instruction
Form M-12C LTFC Client Questionnaire LTFC Client Questionnaire (Form M-12C).docx	Form and Instruction

IC Title:

Long Term Foster Care Client Questionnaire (M-12C) - Respondents

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

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
Form and Instruction	Form M-12C	LTFC Client Questionnaire	LTFC Client Questionnaire (Form M-12C).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: 75

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	75	75
Annual IC Time Burden (Hours)	38	38
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.