Information Collection

Semi-annual progress report for the Children and Youth Exposed to Violence Program

IC 202893 under ICR 201206-1122-002 · OMB 1122-0028.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1122-0028 can be found here:

Documents and Forms

Document Name Document Type
Form 1122-XXXX Semi-annual progress report for the Children and Youth Exposed to Violence Program Form
1122-XXXX Semi-annual Progress Report for Children and Youth Expos CEV pretty form FINAL_8_16_12.pdf www.gms.gov Form
CEV instructions FINAL 8_16_12_Updated.docx Instructions for Semi-annual Progress Report for Children and Youth Exposed to Violence Program IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Semi-annual progress report for the Children and Youth Exposed to Violence Program	Agency IC Tracking Number:	1122-XXXX

Is this a Common Form? No		IC Status: New

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	1122-XXXX	Semi-annual Progress Report for Children and Youth Exposed to Violence Program	CEV pretty form FINAL_8_16_12.pdf	www.gms.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Instructions for Semi-annual Progress Report for Children and Youth Exposed to Violence Program	CEV instructions FINAL 8_16_12_Updated.docx	08/27/2012

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