Information Collection

Public Sector

IC 187919 under ICR 200901-0970-004 · OMB 0970-0365.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0365 can be found here:

Documents and Forms

Document Name Document Type
Attach C_HM Performance_Combined.pdf Other-Att C
Attach E_RF Performance_Combined.pdf Other-Att E
Attach G_Comment Sheet.doc Other-Att G
Attach B_Data entry instructions.doc Att B IC Document
Attach D_Glossary_HM.doc Att D IC Document
Attach F_Glossary_RF.doc Att F IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Public Sector	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Att C	Attach C_HM Performance_Combined.pdf	No	No	Fillable Printable
Other-Att E	Attach E_RF Performance_Combined.pdf	Yes	Yes	Fillable Printable
Other-Att G	Attach G_Comment Sheet.doc	Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 24	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	48	48
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att B	Attach B_Data entry instructions.doc	01/15/2009
Att D	Attach D_Glossary_HM.doc	01/15/2009
Att F	Attach F_Glossary_RF.doc	01/15/2009

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.