Information Collection

State Profile Sheet - State Supplementation Programs For The Aged, Blind And Disabled

IC 115217 under ICR 198203-0960-014 · OMB 0960-0291.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

STATE PROFILE SHEET - STATE SUPPLEMENTATION PROGRAMS FOR THE AGED, BLIND AND DISABLED

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-4965				No	No
Form	(2-82)				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: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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