Information Collection

Ofa-100

IC 189465 under ICR 201208-0970-006 · OMB 0970-0366.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 OFA-100	Form
1 OFA-100 OFA-100 form.doc	Form
OFA-100 instructions.doc OFA-100 instructions	IC Document

IC Title:

OFA-100

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	OFA-100	OFA-100 form.doc		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: 6

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	18	-447	465
Annual IC Time Burden (Hours)	432	-10,728	11,160
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OFA-100 instructions	OFA-100 instructions.doc	08/27/2012

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