Information Collection

Assessment and Service Delivery State Lead Interviews-Supplemental Questions

IC 226794 under ICR 202306-0970-013 · OMB 0970-0501.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
TAB K_Assessment and Service Delivery State Lead Interview - Supplemental Questions.docx	Other-Supplemental Questions
TAB K_Assessment and Service Delivery State Lead Interview - Supplemental Questions.docx	Other-Supplemental Questions

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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-Supplemental Questions			TAB K_Assessment and Service Delivery State Lead Interview - Supplemental Questions.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-30	30
Annual IC Time Burden (Hours)	-15	15
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.