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No Wrong Door System Management Tool-State and Local Level
No Wrong Door System Management Tool
OMB: 0985-0062
IC ID: 234839
OMB.report
HHS/ACL
OMB 0985-0062
ICR 202204-0985-001
IC 234839
( )
Documents and Forms
Document Name
Document Type
No Wrong Door System Management Tool-State and Local Level
Form and Instruction
NWD System Management Tool
0062 NWD System Management Tool Ext 2022.pdf
Form and Instruction
NWD System Management Tool
0062 NWD System Management Tool Ext 2022.pdf
Form and Instruction
NWD ADRC COVID
0062 NWD_ADRC_COVID_Grant_Second Semi Annual Report.pdf
Form and Instruction
NWD ADRC COVID
0062 NWD_ADRC_COVID_Grant_Second Semi Annual Report.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
No Wrong Door System Management Tool-State and Local Level
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
Form and Instruction
NA
NWD System Management Tool
0062 NWD System Management Tool Ext 2022.pdf
Yes
Yes
Fillable Fileable Signable
Form and Instruction
NA
NWD ADRC COVID
0062 NWD_ADRC_COVID_Grant_Second Semi Annual Report.pdf
Yes
Yes
Fillable Fileable Signable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
265
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 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
530
0
0
-1,574
0
2,104
Annual IC Time Burden (Hours)
5,060
0
0
-3,020
0
8,080
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.