Information Collection

Election Form

IC 10015 under ICR 200709-0970-003 · OMB 0970-0196.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0196 can be found here:

Documents and Forms

Document Name Document Type
01 MSFIDM Data Match Specifications 04.14.05.pdf Other-insturment

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Election Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Other-insturment			01 MSFIDM Data Match Specifications 04.14.05.pdf		No	No	Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 71	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 99 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	71	-18,266	18,337
Annual IC Time Burden (Hours)	36	-9,132	9,168
Annual IC Cost Burden (Dollars)	0	-17,000	17,000

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.