Information Collection

Community Care Hub Competency Assessment: A Self-Attestation Tool – Vetting of Tool Items

IC 273664 under ICR 202405-0985-001 · OMB 0985-0081.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ACL CCH Self-Attestation Assessment Community Care Hub Competency Assessment: A Self-Attestation Tool – Vetting of Tool Items	Form and Instruction
ACL CCH Self-Attestation Assessment 0081 ACL CCH Self-Attestation Assessment Ins_011425.docx	Form and Instruction
0081 CCH Competency Assessment Qual Research Gen Short Form_011425.docx Qualitative Research and Assessment Generic IC Short Form	IC Document

IC Title:

Community Care Hub Competency Assessment: A Self-Attestation Tool â Vetting of Tool Items

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
Form and Instruction	NA				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: 25

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Qualitative Research and Assessment Generic IC Short Form		01/14/2025

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

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