Information Collection

Annual Self-Assessment

IC 221995 under ICR 202502-0970-017 · OMB 0970-0307.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0307 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Annual Self-Assessment	Form and Instruction
Form 1 State Court Improvement Program 2023 Annual Self-Assessment Report Annual Self-Assessment	Form and Instruction
1 State Court Improvement Program 2023 Annual Self-Assessm Attachment B ACYF-CB-PI-25-xx Self Assessment PRA EO 2025.docx	Form and Instruction
1 State Court Improvement Program 2023 Annual Self-Assessm Attachment B ACYF-CB-PI-25-xx Self Assessment PRA EO 2025 tc-cln 2.21.25.docx	Form and Instruction

IC Title:

Annual Self-Assessment

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
Form and Instruction	1				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: 53

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	Previously Approved
Annual Number of Responses for this IC	53	53
Annual IC Time Burden (Hours)	2,120	2,120
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.

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