Information Collection

Client Service Use and Delivery

IC 239401 under ICR 202310-0970-012 · OMB 0970-0542.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0542 can be found here:

Documents and Forms

Document Name Document Type
Form 4 Client Service Use and Delivery Form
FY24 DVHT Reporting Reference Guide_Clean.docx Instruction
4 Client Service Use and Delivery Form FY24 DVHT Performance Indicators_Clean.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Client Service Use and Delivery	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	4	Client Service Use and Delivery Form	FY24 DVHT Performance Indicators_Clean.docx		Yes	Yes	Printable Only
Instruction			FY24 DVHT Reporting Reference Guide_Clean.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: 1,700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	567	567
Annual IC Time Burden (Hours)	142	142
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.