Information Collection

Grants to States for Access and Visitation (Local Service Providers)

IC 187256 under ICR 200811-0970-002 · OMB 0970-0204.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0204 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Grants to States for Access and Visitation (Local Service Providers)	Form and Instruction
1 Local Services Providers Form RevisedPartIILocalServiceProviderSurveyFINAL JULY 2008.doc	Form and Instruction
1 Print Copy of LOCAL AV SURVEY Feb 26 Print Copy of Local AV Survey Spreadsheet.xls	Form
1 Local Service Provider Survey RevisedPartIILocalServiceProviderSurveyFINAL JULY 2008.doc	Form and Instruction
1 Print Copy of Local AV Survey Spreadsheet April 24 Print Copy of Local AV Survey Spreadsheet (2).xls	Form

IC Title:

Grants to States for Access and Visitation (Local Service Providers)

Agency IC Tracking Number:

Is this a Common Form? Yes

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 303

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 and Instruction	1	Local Services Providers Form	RevisedPartIILocalServiceProviderSurveyFINAL JULY 2008.doc	Yes	Yes	Printable Only
Form	1	Print Copy of LOCAL AV SURVEY	Feb 26 Print Copy of Local AV Survey Spreadsheet.xls	Yes	No	Fillable Printable
Form and Instruction	1	Local Service Provider Survey	RevisedPartIILocalServiceProviderSurveyFINAL JULY 2008.doc	Yes	Yes	Fillable Printable
Form	1	Print Copy of Local AV Survey Spreadsheet	April 24 Print Copy of Local AV Survey Spreadsheet (2).xls	Yes	No	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 260

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	260	260
Annual IC Time Burden (Hours)	3,900	3,900
Annual IC Cost Burden (Dollars)	0	0

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.