RSAF - Collateral

Recovery Services for Adolescents and Families (RSAF)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0311 can be found here:

Documents and Forms

Document Name Document Type
Form Collateral Instrum RSAF - Collateral Form and Instruction
Collateral Instrum Collateral Instruments Collateral Instruments.zip Form and Instruction

Information Collection (IC) Details

IC Title:	RSAF - Collateral	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
Form and Instruction	Collateral Instruments	Collateral Instruments	Collateral Instruments.zip		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	910	910
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.