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Disaster Human Services Case Management Intake Assessment – Survivor
Office of Human Services Emergency Preparedness and Response Disaster Human Services Case Management Intake Assessment, Resource Referral, and Case Management Plan
OMB: 0970-0619
IC ID: 262629
OMB.report
HHS/ACF
OMB 0970-0619
ICR 202401-0970-017
IC 262629
( )
Documents and Forms
Document Name
Document Type
Form 1
Disaster Human Services Case Management Intake Assessment – Survivor
Form and Instruction
1 Disaster Human Services Case Management Intake Assessmen
1 - ACF OHSEPR Disaster Human Services Case Management Intake Assessment Form.docx
Form and Instruction
1 Disaster Human Services Case Management Intake Assessmen
1 - ACF OHSEPR Disaster Human Services Case Management Intake Assessment Form.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Disaster Human Services Case Management Intake Assessment – Survivor
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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
Disaster Human Services Case Management Intake Assessment Form
1 - ACF OHSEPR Disaster Human Services Case Management Intake Assessment Form.docx
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:
OHESPR Repatriation and Disaster Human Services Case Management Records
FR Citation:
88 FR 63109
Number of Respondents:
9,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
95 %
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
9,000
0
0
0
0
9,000
Annual IC Time Burden (Hours)
13,500
0
0
0
0
13,500
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.