Information Collection

Enrollment and services data: Service log entries (Appendix E)

IC 234663 under ICR 201901-0970-001 · OMB 0970-0527.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0527 can be found here:

Documents and Forms

Document Name Document Type
Appendix E_Enrollment and Service Data Elements.pdf Other-Data Elements

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Enrollment and services data: Service log entries (Appendix E)	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-Data Elements			Appendix E_Enrollment and Service Data Elements.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 162	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	370,656	367,173	3,483
Annual IC Time Burden (Hours)	11,120	10,249	871
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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