Information Collection

Jurisdiction Lead Observation Debrief

IC 260178 under ICR 202305-0970-012 · OMB 0970-0401.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0401 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Jurisdiction Lead Observation Debrief.docx	Other-Debrief
Jurisdiction Lead Observation Debrief.docx	Other-Debrief
Application - Jurisdiction Lead Observation Debrief_mj - Clean.docx Fast Track GenIC - Jurisdiction Lead Observation Debrief	IC Document
Application - Jurisdiction Lead Observation Debrief_mj - Clean.docx Fast Track GenIC - Jurisdiction Lead Observation Debrief	IC Document
Recruitment Messages - Jurisdiction Lead Observation Debrief.docx Recruitment Material - Jurisdiction Lead Observation Debrief	IC Document
Recruitment Messages - Jurisdiction Lead Observation Debrief.docx Recruitment Material - Jurisdiction Lead Observation Debrief	IC Document

IC Title:

Jurisdiction Lead Observation Debrief

Agency IC Tracking Number:

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-Debrief			Jurisdiction Lead Observation Debrief.docx		Yes	Yes	Printable Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 25

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track GenIC - Jurisdiction Lead Observation Debrief	Application - Jurisdiction Lead Observation Debrief_mj - Clean.docx	05/12/2023
Recruitment Material - Jurisdiction Lead Observation Debrief	Recruitment Messages - Jurisdiction Lead Observation Debrief.docx	05/12/2023

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