Information Collection

Appendix A_NSCH-LC Screener and Topical Questionnaires

IC 261064 under ICR 202307-0607-001 · OMB 0607-1028.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-1028 can be found here:

Documents and Forms

Document Name Document Type
Form Appendix A_NSCH-LC Appendix A_NSCH-LC Questionnaire Drafts Form
Appendix A_NSCH-LC Appendix A_NSCH-LC Questionnaire Appendix A_NSCH-LC Questionnaire Drafts (3).pdf Form
Appendix A_NSCH-LC Appendix A_NSCH-LC Screener and Topical Questionnaires Appendix A_NSCH-LC Screener and Topical Questionnaires.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Appendix A_NSCH-LC Screener and Topical Questionnaires	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Appendix A_NSCH-LC	Appendix A_NSCH-LC Screener and Topical Questionnaires	Appendix A_NSCH-LC Screener and Topical Questionnaires.pdf		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: 45,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	45,000	45,000
Annual IC Time Burden (Hours)	30,000	30,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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