Information Collection

CCWIS Self-Assessment – Intake

IC 245127 under ICR 202311-0970-010 · OMB 0970-0568.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0568 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CCWIS Intake Self-Assessment Tool v1.0.docx	Other-Self-Assessment Tool
CCWIS Intake Self-Assessment Tool v1.0.docx	Other-Self-Assessment Tool

IC Title:

CCWIS Self-Assessment â Intake

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-Self-Assessment Tool			CCWIS Intake Self-Assessment Tool v1.0.docx		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: 55

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	55	55
Annual IC Time Burden (Hours)	550	550
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.