Information Collection

93.587

IC 179666 under ICR 201208-0970-005 · OMB 0970-0139.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0139 can be found here:

Documents and Forms

Document Name Document Type
93.587.mht Other-93.587

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	93.587	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-93.587			93.587.mht		No	No	Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 177	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	177	142	35
Annual IC Time Burden (Hours)	10,620	9,220	1,400
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.