Information Collection

Child and Family Services Review Statewide Assessment

IC 191017 under ICR 201202-0970-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 1 Child and Family Services Review Statewide Assessment Form and Instruction
1 Statewide Assessment Statewide_Assessment1 08-26-2009.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

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
Form and Instruction	1	Statewide Assessment	Statewide_Assessment1 08-26-2009.doc		Yes	Yes	Fillable Printable

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

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.