Information Collection

CCWIS Self-Assessment: Adoption

IC 267090 under ICR 202404-0970-008 · OMB 0970-0568.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Evidence for Self-Assessment Tool - Adoption - 2022-07-26.docx	Other-Self-Assessment Tool
Evidence for Self-Assessment Tool - Adoption - 2022-07-26.docx	Other-Self-Assessment Tool
Submission Form - CCWIS Generic - 0970-0568 - Adoption v2.docx GenIC - CCWIS Self-Assessment (Adoption)	IC Document
Submission Form - CCWIS Generic - 0970-0568 - Adoption v2.docx GenIC - CCWIS Self-Assessment (Adoption)	IC Document

IC Title:

Agency IC Tracking Number:

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
Other-Self-Assessment Tool			Evidence for Self-Assessment Tool - Adoption - 2022-07-26.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: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
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
GenIC - CCWIS Self-Assessment (Adoption)	Submission Form - CCWIS Generic - 0970-0568 - Adoption v2.docx	04/19/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.