Information Collection

Office of Community Care – SEOC Survey

IC 276373 under ICR 202503-2900-010 · OMB 2900-0876.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0876 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2900-0876 Office o 2900-0816 Office of Community Care – SEOC Survey Office of Community Care – SEOC Survey	Form and Instruction
2900-0876 Office o 2900-0816 Office of Community Care – SEOC Survey OCC SEOC Wireframe 20250620.docx	Form and Instruction
A11 Fast-Track Clarance Request Template_OCC_SEOC_Survey.docx Office of Community Care – SEOC Survey	IC Document

IC Title:

Office of Community Care â SEOC Survey

Agency IC Tracking Number:

2900-0876 Office of Community Care â SEOC Survey

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	2900-0876 Office of Community Care â SEOC Survey				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 750

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
Annual Number of Responses for this IC	750	750
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Office of Community Care â SEOC Survey		07/16/2025

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

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