Information Collection

2024 NSECE Home-based Provider Screener and Questionnaire (listed home-based providers)

IC 259975 under ICR 202409-0970-004 · OMB 0970-0391.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 2 2024 NSECE Home-based Provider Q Eng clean_toOPRE_070324.docx	Other-Screener and Questionnaire (En
Instrument 2 2024 NSECE Home-based Provider Q Eng clean_toOPRE_070324.docx	Other-Screener and Questionnaire (En
Instrument 2S 2024 NSECE Home-based Provider Q Span_toOPRE_070324.docx	Other-Screener and Questionnaire (Sp
Instrument 2S 2024 NSECE Home-based Provider Q Span_toOPRE_070324.docx	Other-Screener and Questionnaire (Sp

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-Screener and Questionnaire (English)			Instrument 2 2024 NSECE Home-based Provider Q Eng clean_toOPRE_070324.docx		Yes	Yes	Fillable Fileable
Other-Screener and Questionnaire (Spanish)			Instrument 2S 2024 NSECE Home-based Provider Q Span_toOPRE_070324.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title: OPRE Research and Evaluation Project Records

FR Citation: 87 FR 57198

Number of Respondents: 946

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	946	-3,414	4,360
Annual IC Time Burden (Hours)	634	-2,287	2,921
Annual IC Cost Burden (Dollars)	0	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.