Jurisdiction Lead Observation Debrief Protocol

Center for States Evaluation Ancillary Data Collection

Documents and Forms

Document Name Document Type
4 - Jurisdiction Lead Observation Debrief Protocol.docx Other-Debrief Protocol
4 - Jurisdiction Lead Observation Debrief Protocol.docx Other-Debrief Protocol

Information Collection (IC) Details

IC Title:	Jurisdiction Lead Observation Debrief Protocol	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-Debrief Protocol			4 - Jurisdiction Lead Observation Debrief Protocol.docx		Yes	Yes	Printable Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	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: 80 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	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.