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UCEDD: Self-administered Form
Developmental Disabilities Program Independent Evaluation Project
OMB: 0985-0031
IC ID: 189891
OMB.report
HHS/ACL
OMB 0985-0031
ICR 201205-0985-008
IC 189891
( )
Documents and Forms
Document Name
Document Type
Form 19
UCEDD: Self-administered Form
Form and Instruction
19 UCEDD: Self-administered Form
UCEDD SELF ADMINISTERED FORM.doc
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
UCEDD: Self-administered Form
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
Form and Instruction
19
UCEDD: Self-administered Form
UCEDD SELF ADMINISTERED FORM.doc
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Social Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
20
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
20
0
0
0
0
20
Annual IC Time Burden (Hours)
830
0
0
0
0
830
Annual IC Cost Burden (Dollars)
0
0
0
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.