Information Collection

Long Format for Assisted

IC 184198 under ICR 200803-0970-010 · OMB 0970-0060.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0060 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Assisted 08 Long Format for Assisted	Form
Form 1 Assisted 09 Long Format for Assisted	Form
Form 1 Assisted 09 Long Format for Assisted	Form
1 Assisted 08 hhsrptst08_assisted households.xls	Form
1 Assisted 09 hhsrptst09_assisted households.xls	Form
1 Assisted 09 hhsrptst09_assisted households.xls	Form

IC Title:

Long Format for Assisted

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 96.82

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	No	No	Paper Only
Form	1	No	No	Paper Only
Form	1	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: 52

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
Annual Number of Responses for this IC	52	52
Annual IC Time Burden (Hours)	9,880	9,880
Annual IC Cost Burden (Dollars)	2,236	2,236

Documents for IC

table that charts IC Documents
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.

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