Information Collection

Collection Instruments - State & Local Agencies

IC 182700 under ICR 200711-0584-003 · OMB 0584-0547.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0547 can be found here:

Documents and Forms

Document Name Document Type
State Level Survey.pdf Other-Survey
State Level Interview.pdf Other-Interview Guide
Local Level Survey.pdf Other-Survey
Local Level Interview.pdf Other-Interview Guide
Partner Organization Survey.pdf Other-Survey
Advance Ltr to States.pdf Other-Letter
Advance Ltr to Local Offices.pdf Other-Letter
Partner Agency Interview.pdf Other-Interview Guidelines

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Collection Instruments - State & Local Agencies	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey	State Level Survey.pdf	Yes	Yes	Fillable Fileable
Other-Interview Guide	State Level Interview.pdf	No		Paper Only
Other-Survey	Local Level Survey.pdf	Yes	Yes	Fillable Fileable
Other-Interview Guide	Local Level Interview.pdf	No		Paper Only
Other-Survey	Partner Organization Survey.pdf	Yes	Yes	Fillable Fileable
Other-Letter	Advance Ltr to States.pdf	No		Paper Only
Other-Letter	Advance Ltr to Local Offices.pdf	No		Paper Only
Other-Interview Guidelines	Partner Agency Interview.pdf	No		Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 771	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 20 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	972	972
Annual IC Time Burden (Hours)	1,349	1,349
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.