Information Collection

Enrollment and services data: Service log entries (Appendix F)

IC 234663 under ICR 202506-0970-007 · OMB 0970-0527.

Documents and Forms

Documents and forms in this information collection
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

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-Data Elements					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: 108

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	168,480	-168,480	336,960
Annual IC Time Burden (Hours)	5,054	-6,178	11,232
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.

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