Form CB-496, "Title IV-E Program Quarterly Financial Report

IV-E Foster Care and Adoption Assistance Quarterly Financial Report

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0205 can be found here:

Documents and Forms

Document Name Document Type
Form CB-496 Form CB-496, "Title IV-E Program Quarterly Financial Report Form
CB-496 IV-E, Program Quarterly Financial Report Form CB-496 - FINAL DRAFT - May 2010.pdf Form
Instructions - FINAL DRAFT - Form CB-496 - May 2010.pdf Instructions IC Document

Information Collection (IC) Details

IC Title:	Form CB-496, "Title IV-E Program Quarterly Financial Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CB-496	IV-E, Program Quarterly Financial Report	Form CB-496 - FINAL DRAFT - May 2010.pdf		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: 62	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Program Change Due to New Statute	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	248	40	0	208
Annual IC Time Burden (Hours)	4,216	888	0	3,328
Annual IC Cost Burden (Dollars)	0	0	-66,560	66,560

Documents for IC

Title	Document	Date Uploaded
Instructions	Instructions - FINAL DRAFT - Form CB-496 - May 2010.pdf	05/11/2010

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