Information Collection

Public Sector

IC 187919 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 1 Public Sector Form and Instruction
1 HM Combined B - HM Combined OMB.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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Public 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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	HM Combined	B - HM Combined OMB.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: 15	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	30	-18	48
Annual IC Time Burden (Hours)	24	-14	38
Annual IC Cost Burden (Dollars)	0	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.