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Information Collection

2024 NSECE Home-based Provider Screener and Questionnaire (unlisted home-based providers)

IC 259976 under ICR 202305-0970-005 · OMB 0970-0391.

Documents and Forms
Document Name
Document Type
Other-Screener and Questionnaire (En
Other-Screener and Questionnaire (En
Other-Screener and Questionnaire (Sp
Other-Screener and Questionnaire (Sp
Information Collection (IC) Details

View Information Collection (IC)

2024 NSECE Home-based Provider Screener and Questionnaire (unlisted home-based providers)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Screener and Questionnaire (English) Instrument 2 2024 NSECE Home-based Provider Screener and Questionnaire_toOPRE_042823.docx Yes Yes Fillable Fileable
Other-Screener and Questionnaire (Spanish) Instrument 2S 2024 NSECE Home-based Provider Screener and Questionnaire (Spanish)_toOPRE_042823.docx Yes Yes Fillable Fileable

Community and Social Services Social Services

 

1,158 0
   
Individuals or Households
 
   80 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,158 0 1,158 0 0 0
Annual IC Time Burden (Hours) 382 0 382 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.