Information Collection

Enrollment and services data: Case closure – prenatal (Appendix F)

IC 234662 under ICR 202506-0970-007 · OMB 0970-0527.

Documents and Forms

Document Name Document Type
Appendix F_Enrollment and Services_Data Elements.docx Other-Data Elements
Appendix F_Enrollment and Services_Data Elements.docx Other-Data Elements

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Enrollment and services data: Case closure â prenatal (Appendix F)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Data Elements			Appendix F_Enrollment and Services_Data Elements.docx		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: 18	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	180	-180	360
Annual IC Time Burden (Hours)	4	-2	6
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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

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