Information Collection

EBHV agency fidelity/cost web-based data entry

IC 191205 under ICR 200911-0970-002 · OMB 0970-0375.

Documents and Forms

Document Name Document Type
3.Agency Fidelity Cost Web-Based Data Entry.doc Other-EBHV agency fidelity/cost web-

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	EBHV agency fidelity/cost web-based data entry	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-EBHV agency fidelity/cost web-based data entry			3.Agency Fidelity Cost Web-Based Data Entry.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: 50	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	5,400	5,400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.