Information Collection

Case Management Intake

IC 212081 under ICR 202501-0704-003 · OMB 0704-0528.

Documents and Forms

Document Name Document Type
0704-0528_CMS Screenshots_4.7.2025.docx Other-Screenshots
0704-0528_CMS Screenshots_4.7.2025.docx Other-Screenshots
0704-0528_ADN_2.27.2025.docx Agency Disclosure Notice IC Document
0704-0528_ADN_2.27.2025.docx Agency Disclosure Notice IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Case Management Intake	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screenshots			0704-0528_CMS Screenshots_4.7.2025.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 242,711	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	242,711	22,988	219,723
Annual IC Time Burden (Hours)	242,711	22,988	219,723
Annual IC Cost Burden (Dollars)	1,759,655	1,361,956	397,699

Documents for IC

Title	Document	Date Uploaded
Agency Disclosure Notice	0704-0528_ADN_2.27.2025.docx	02/27/2025

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