Information Collection

Dbra/cwhssa Recordkeeping And Reporting Requirement (sf 1444)

IC 162078 under ICR 199003-9000-001 · OMB 9000-0089.

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Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

DBRA/CWHSSA RECORDKEEPING AND REPORTING REQUIREMENT (SF 1444)

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:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	SFXXX2	No	No
Form	SFXXX3	No	No
Form	SFXXX1	No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 630

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	630	629	1
Annual IC Time Burden (Hours)	630	0	630
Annual IC Cost Burden (Dollars)	0	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.