Information Collection

State Self-Assessment Review and Report

IC 10062 under ICR 202202-0970-014 · OMB 0970-0223.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0223 can be found here:

Documents and Forms

Document Name Document Type
Form 1 State Self-Assessment Review and Report Form and Instruction
1 CSE Program Self-Assessment Report SAR Reporting Format and Instructions -0970-0223_Final_10.22.21.docx Form and Instruction
1 CSE Program Self-Assessment Report SAR Reporting Format and Instructions -0970-0223_Final_10.22.21.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State Self-Assessment Review and Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 308

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	CSE Program Self-Assessment Report	SAR Reporting Format and Instructions -0970-0223_Final_10.22.21.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: 54	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	54	0	54
Annual IC Time Burden (Hours)	432	216	216
Annual IC Cost Burden (Dollars)	0	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.