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Information Collection

2024 NSECE Center-based Provider Screener and Questionnaire

IC 259978 under ICR 202309-0970-011 · 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 Center-based Provider Screener and Questionnaire
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Screener and Questionnaire (English) Instrument 3 2024 NSECE Center-based Provider Screener and Questionnaire_toOPRE_092123.docx Yes Yes Fillable Fileable
Other-Screener and Questionnaire (Spanish) Instrument 3S 2024 NSECE Center-based Provider Screener and Questionnaire (Spanish)_toOPRE_092123.docx Yes Yes Fillable Fileable

Community and Social Services Social Services

 

8,392 0
   
Individuals or Households
 
   0 %

  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 8,392 0 0 0 0 8,392
Annual IC Time Burden (Hours) 6,294 0 0 0 0 6,294
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.