Information Collection

Instrument 4a: Introductory script - Program Staff Burden

IC 205999 under ICR 201303-0970-001 · OMB 0970-0403.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0403 can be found here:

Documents and Forms

Document Name Document Type
PACT Instrument (4) - HM Introductory Script - 2-19-13.docx Other-Script

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Instrument 4a: Introductory script - Program Staff Burden	Agency IC Tracking Number:

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
Other-Script			PACT Instrument (4) - HM Introductory Script - 2-19-13.docx		No	No	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	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	2,100	2,100
Annual IC Time Burden (Hours)	351	351
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.