Information Collection

Appendix A_NSCH-LC Screener and Topical Questionnaires

IC 261064 under ICR 202307-0607-001 · OMB 0607-1028.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-1028 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Appendix A_NSCH-LC Appendix A_NSCH-LC Questionnaire Drafts	Form
Appendix A_NSCH-LC Appendix A_NSCH-LC Questionnaire Appendix A_NSCH-LC Questionnaire Drafts (3).pdf	Form
Appendix A_NSCH-LC Appendix A_NSCH-LC Screener and Topical Questionnaires Appendix A_NSCH-LC Screener and Topical Questionnaires.pdf	Form

IC Title:

Appendix A_NSCH-LC Screener and Topical Questionnaires

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Form	Appendix A_NSCH-LC	Appendix A_NSCH-LC Screener and Topical Questionnaires	Appendix A_NSCH-LC Screener and Topical Questionnaires.pdf		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: 45,000

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	45,000	45,000
Annual IC Time Burden (Hours)	30,000	30,000
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.