Information Collection

Ofa-100

IC 189465 under ICR 200906-0970-001 · OMB 0970-0366.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0366 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OFA-100 OFA-100	Form
EF request instruct 6 04 09.doc	Instruction
OMB Questions on Form OFA-100 (3).doc	Instruction
OFA-100 TANF Emergency Fund Request Form EF form - OFA-100 05-08.doc	Form

IC Title:

OFA-100

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	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	OFA-100	TANF Emergency Fund Request Form	EF form - OFA-100 05-08.doc	Yes	Yes	Paper Only
Instruction			EF request instruct 6 04 09.doc	Yes	No	Paper Only
Instruction			OMB Questions on Form OFA-100 (3).doc	Yes	No	Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 93

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 New Statute
Annual Number of Responses for this IC	465	465
Annual IC Time Burden (Hours)	11,160	11,160
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.