Information Collection

Appendix A - Phone Screener for Prospective Families

IC 232313 under ICR 201807-0970-016 · OMB 0970-0523.

Documents and Forms

Document Name Document Type
Appendix A - Phone Screener for Prospective Families.docx Other-Screener

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Appendix A - Phone Screener for Prospective Families	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-Screener			Appendix A - Phone Screener for Prospective Families.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	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	120	120
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.