Information Collection

Grants to States for Access and Visitation (Local Service Providers)

IC 187256 under ICR 201204-0970-004 · OMB 0970-0204.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0204 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Grants to States for Access and Visitation (Local Service Providers) Form
1 Local Spread Sheet FY 2013-2015 Local Spread Sheet FINAL April 11 2012.xls Form
Attachment A Revised AVSurvey March 11 2012 (16) FINAL.docx Child Access Survey Instructions IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Grants to States for Access and Visitation (Local Service Providers)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 303

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Local Spread Sheet	FY 2013-2015 Local Spread Sheet FINAL April 11 2012.xls		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: 300	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	300	40	260
Annual IC Time Burden (Hours)	4,800	900	3,900
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Child Access Survey Instructions	Attachment A Revised AVSurvey March 11 2012 (16) FINAL.docx	04/23/2012

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