Information Collection

Short Format

IC 184199 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⚠️ Notice: This information collection may be referencing outdated material.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 short short format Short Format	Form
Form 1 09 Short Format	Form
Form 1 short Short Format	Form
short short format hhsrptin08.xls	Form
1 09 hhsrptin09.xls	Form
1 short hhsrptin10.xls	Form

IC Title:

Short Format

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 34 CFR 45

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	short	short format	hhsrptin08.xls	No	No	Paper Only
Form	1	09	hhsrptin09.xls	No	No	Paper Only
Form	1	short	hhsrptin10.xls	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: 144

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	144	144
Annual IC Time Burden (Hours)	144	144
Annual IC Cost Burden (Dollars)	6,192	6,192

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.