Information Collection

HBCC-NSAC Toolkit provider questionnaire

IC 264187 under ICR 202405-0970-007 · OMB 0970-0625.

Documents and Forms

Document Name Document Type
Instrument 5. HBCC-NSAC Toolkit Provider Questionnaire_10.21.23_clean.docx Other-Questionnaire
Instrument 5. HBCC-NSAC Toolkit Provider Questionnaire_10.21.23_clean.docx Other-Questionnaire

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	HBCC-NSAC Toolkit provider questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Other-Questionnaire			Instrument 5. HBCC-NSAC Toolkit Provider Questionnaire_10.21.23_clean.docx		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: 224	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	224	74	150
Annual IC Time Burden (Hours)	186	61	125
Annual IC Cost Burden (Dollars)	0	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.