Information Collection

Eligibility Statement For State Child Abuse And Neglect Programs (hew Form 627) Explanation Of Hew Form 627

IC 116049 under ICR 197912-0980-005 · OMB 0980-0005.

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Information Collection (IC) Details

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IC Title:	ELIGIBILITY STATEMENT FOR STATE CHILD ABUSE AND NEGLECT PROGRAMS (HEW FORM 627) EXPLANATION OF HEW FORM 627	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

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	HEW 627				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

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