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Web-Based Survey
National Study of Title IV-E Child Welfare Waiver Demonstrations
OMB: 0970-0495
IC ID: 223975
OMB.report
HHS/ACF
OMB 0970-0495
ICR 201610-0970-006
IC 223975
( )
Documents and Forms
Document Name
Document Type
Form 1
Web-Based Survey
Form and Instruction
1 National Study Web-Based Survey
Attachment 2_National Study_Web-Based Survey_10.19.16.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Web-Based Survey
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 and Instruction
1
National Study Web-Based Survey
Attachment 2_National Study_Web-Based Survey_10.19.16.docx
Yes
Yes
Fillable Printable
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:
250
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
100 %
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
250
0
250
0
0
0
Annual IC Time Burden (Hours)
83
0
83
0
0
0
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.