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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Baseline information form for participants (Attachment D)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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-Standard BIF
BEES_NonSub Change Request_Attachment D-Generic BIF CLEAN_Nov-Dec 2020.docx
Yes
Yes
Fillable Fileable
Other-Tailored BIF - ARC Site
Attachment D-1_BEES_BIF ARC_Clean.docx
Yes
Yes
Fillable Fileable
Other-Tailored BIF - CCC Site
Attachment D-2_BEES_BIF CCC_Clean.docx
Yes
Yes
Fillable Fileable
Other-Tailored BIF - Franklin-Stark Site
Attachment D-3_BEES_BIF Franklin-Stark_Clean.docx
Yes
Yes
Fillable Fileable
Other-Tailored BIF - 2Gen-Chicago Site
Attachment D-4_BEES_BIF 2Gen-Chicago_Clean.docx
Yes
Yes
Fillable Fileable
Other-Tailored BIF - IPS FQHC site
Attachment D-5_BEES_BIF IPS FQHC_Clean.docx
Yes
Yes
Fillable Fileable
Other-Tailored BIF - IPS SUD
Attachment D-1_BEES_IPS SUD BIF_May 2021_Clean.docx
Yes
Yes
Fillable Fileable
Other-Tailored BIF - TANF-SNAP study
BEES_NonSub Change Request_Attachment D-BIF-TANF-SNAP study.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Social Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
4,133
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
4,133
0
0
0
0
4,133
Annual IC Time Burden (Hours)
1,034
0
0
0
0
1,034
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.