Socea

National System of Care (SOC) Expansion Evaluation

Documents and Forms

Document Name Document Type
Form SOCEA SOCEA Form and Instruction
SOCEA SOCEA Attachment 8 SOCEA protocols.docx Form and Instruction
Attachment 1 Logic Model 12-17-14.docx Evaluation Logic Model IC Document

Information Collection (IC) Details

IC Title:	SOCEA	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
Form and Instruction	SOCEA	SOCEA	Attachment 8 SOCEA protocols.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 858	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	858	858
Annual IC Time Burden (Hours)	1,063	1,063
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Evaluation Logic Model	Attachment 1 Logic Model 12-17-14.docx	01/08/2015

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