Information Collection

Child and Family Services Review Statewide Assessment

IC 191017 under ICR 201112-0970-001 · OMB 0970-0214.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0214 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Child and Family Services Review Statewide Assessment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 1355.33(b)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 25 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	14	1	13
Annual IC Time Burden (Hours)	3,360	240	3,120
Annual IC Cost Burden (Dollars)	67,200	67,200	0

Documents for IC

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