Information Collection

PSB-CY Child Information

IC 248372 under ICR 202412-0704-009 · OMB 0704-0620.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
PSBCY IS Incident Intake.pdf	Other-Database Screenshots
PSBCY IS Incident Intake Updated.pdf	Other-Database Screenshots
dd3179_NCRT.pdf	Other-Referral Tool
dd3179 (2).pdf	Other-Referral Tool

IC Title:

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Database Screenshots			PSBCY IS Incident Intake Updated.pdf		Yes	Yes	Fillable Fileable Signable
Other-Referral Tool			dd3179 (2).pdf		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,500	500	2,000
Annual IC Time Burden (Hours)	2,500	500	2,000
Annual IC Cost Burden (Dollars)	75,300	23,800	51,500

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.