Information Collection

Private Sector

IC 187918 under ICR 201206-0970-005 · OMB 0970-0365.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0365 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Private Sector	Form and Instruction
1 HM Combined Attach C_HM Performance_Combined1.pdf	Form and Instruction
1 RF Combined Attach E_RF Performance_Combined1.pdf	Form and Instruction
1 Comment Attach G_Comment Sheet1.doc	Form and Instruction

IC Title:

Private Sector

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	HM Combined	Attach C_HM Performance_Combined1.pdf	Yes	Yes	Fillable Printable
Form and Instruction	1	RF Combined	Attach E_RF Performance_Combined1.pdf	Yes	Yes	Fillable Printable
Form and Instruction	1	Comment	Attach G_Comment Sheet1.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: 103

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	206	-174	380
Annual IC Time Burden (Hours)	165	-139	304
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.