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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.