Web Intake Form

Pilot Intake Form

OMB: 1505-0236

IC ID: 198053

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Web Intake Form
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Screen Shot 6.9.11 Complaint intake screenshot 1.png Yes Yes Fillable Fileable
Other-Screen Shot 6.9.11 Complaint intake screenshot 1.1.png Yes Yes Fillable Fileable
Other-Screen Shot 6.9.11 Complaint intake screenshot 2.png Yes Yes Fillable Fileable
Other-Screen Shot 6.9.11 Complaint intake screenshot 3.png Yes Yes Fillable Fileable
Other-Screen Shot 6.9.11 Complaint intake screenshot 3.1.png Yes Yes Fillable Fileable

Economic Development Industry Sector Income Stabilization

 

56,250 0
   
Individuals or Households
 
   60 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 56,250 56,250 0 0 0 0
Annual IC Time Burden (Hours) 6,563 6,563 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

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