Information Collection

Title IV-E Prevention Services Clearinghouse

IC 263905 under ICR 202607-0970-011 · OMB 0970-0356.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 1_Consultation Discussion Guide.docx	Other-Consultation Discussion Guide
Instrument 2_Consultation Feedback Form.docx	Other-Consultation Feedback Form
Instrument 3_Program Description Review Request.docx	Other-Program Description Review Req
Instrument 4_ManualRequest.docx	Other-Manual Request
PSC OMB Part A.docx SSA - Title IV-E Prevention Services Clearinghouse	IC Document
PSC OMB Part B.docx SSB - Title IV-E Prevention Services Clearinghouse	IC Document
NOA_Title IV-E Prev Srvcs Clrnghs GenIC_Formative Generic Research_0970-0356_1.5.22.pdf NOA - Title IV-E Prevention Services Clearinghouse	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Consultation Discussion Guide	Yes	Yes	Printable Only
Other-Consultation Feedback Form	Yes	Yes	Printable Only
Other-Program Description Review Request	Yes	Yes	Printable Only
Other-Manual Request	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: 215

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	71	71
Annual IC Time Burden (Hours)	88	88
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA - Title IV-E Prevention Services Clearinghouse		12/13/2023
SSB - Title IV-E Prevention Services Clearinghouse		12/13/2023
NOA - Title IV-E Prevention Services Clearinghouse		12/13/2023

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

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