Competency and CIDI Screener

Supported Employment Demonstration (SED) Project

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0806 can be found here:

Documents and Forms

Document Name Document Type
SED Attachments J3-K (05-03-2017).pdf Other-CIDI Screener
SED Attachment J2 (05-03-17).xlsx Other-Additional screener questions

Information Collection (IC) Details

IC Title:	Competency and CIDI Screener	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
Other-CIDI Screener			SED Attachments J3-K (05-03-2017).pdf		No		Paper Only
Other-Additional screener questions			SED Attachment J2 (05-03-17).xlsx		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,000	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	3,000	3,000
Annual IC Time Burden (Hours)	2,000	2,000
Annual IC Cost Burden (Dollars)	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.