Information Collection

New Instrument 4: Performance Reporting System Data Entry Form

IC 203226 under ICR 201207-0970-002 · OMB 0970-0398.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0398 can be found here:

Documents and Forms

Document Name Document Type
PREP PAS+Baseline - Instrument 4 - PRS Data Entry Form - 6-7-12.docx Other-PRS Entry Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	New Instrument 4: Performance Reporting System Data Entry Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-PRS Entry Form			PREP PAS+Baseline - Instrument 4 - PRS Data Entry Form - 6-7-12.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 65	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	65	65
Annual IC Time Burden (Hours)	1,560	1,560
Annual IC Cost Burden (Dollars)	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.