Document
National Center on Substance Abuse and Child Welfare Technical Assistance Request Form
ICR 202611-0970-004 · OMB 0970-0531 · Object 174626700.
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Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | National Center on Substance Abuse and Child Welfare Technical Assistance Request Form |
| Author | Katie Bhatta |
| Last Modified By | Writer |
| File Modified | 2026-06-02 |
| File Created | 2026-11-05 |
| Conversion State | complete |
Extracted Text
National Center on Substance Abuse and Child Welfare Website Technical Assistance Request Information Collection The following technical assistance (TA) request form will be available on the National Center on Substance Abuse and Child Welfare website and will be completed by individuals or agencies requesting TA. Thank you for your interest in the National Center on Substance Abuse and Child Welfare (NCSACW). All NCSACW resources and services are provided at no cost and focus on strategies to support professionals working with families affected by substance use or mental health disorders who are involved in the child welfare and family court systems. Please use this form to request assistance from NCSACW. Fields marked “Required” must be completed. To reduce burden, the request process should take no more than four minutes to complete. The information you provide will be used solely by NCSACW to determine the appropriate resources and services to meet your needs. After submitting the form, a NCSACW team member will contact you by email within one business day. If you have any questions, including those you might have while completing the form, please contact us at [email protected]. • Name (Required) • Email (Required) • Please briefly describe how NCSACW can support your work. (Required) • System (Optional) • State/Province/City/County (Optional) Submit button Confirmation message: “Thank you for your submission. Your request has been received, and a member of our team will follow up via email within one business day.” PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to gather registration information for technical assistance requests from the NCSACW website. Public reporting burden for this collection of information is estimated to average 4 minutes per grantee, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This collection of information is voluntary. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0531 and the expiration date is 09/30/2028. If you have any comments on this collection of information, please contact Surina Amin at [email protected].