Information Collection

National Child Welfare Center for Innovation and Advancement Service Request Form

IC 280044 under ICR 202606-0970-001 · OMB 0970-0531.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0531 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument1_NCWCIA Service Request Form.docx	Other-Request Form
Instrument1_NCWCIA Service Request Form.docx	Other-Request Form
SSA-Formative for ACF Program Support_Service Request Form_clean.docx Prog Supp GenIC - NCWCIA Service Request Form	IC Document
SSA-Formative for ACF Program Support_Service Request Form_clean.docx Prog Supp GenIC - NCWCIA Service Request Form	IC Document

IC Title:

National Child Welfare Center for Innovation and Advancement Service Request Form

Agency IC Tracking Number:

IC Status: Unchanged

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-Request Form					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: 148

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	148	148
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Prog Supp GenIC - NCWCIA Service Request Form		04/21/2026

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

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