Information Collection

Form CB-496, "Title IV-E Program Quarterly Financial Report

IC 10037 under ICR 201306-0970-003 · OMB 0970-0205.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0205 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CB-496 Form CB-496, "Title IV-E Program Quarterly Financial Report	Form
Form CB-496 Instructions - DRAFT May 2013.doc	Instruction
CB-496 Title IV-E Programs Quarterly Financial Report Form CB-496 - DRAFT May 2013 - Parts 1 and 2.pdf	Form
CB-496 Quarterly Financial Report Form CB-496 - DRAFT May 2013 - Part 3.pdf	Form

IC Title:

Form CB-496, "Title IV-E Program Quarterly Financial Report

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CB-496	Title IV-E Programs Quarterly Financial Report	Form CB-496 - DRAFT May 2013 - Parts 1 and 2.pdf	No	No	Fillable Printable
Form	CB-496	Quarterly Financial Report	Form CB-496 - DRAFT May 2013 - Part 3.pdf	Yes	Yes	Fillable Printable
Instruction			Form CB-496 Instructions - DRAFT May 2013.doc	Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 62

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Previously Approved
Annual Number of Responses for this IC	248	0	248
Annual IC Time Burden (Hours)	4,960	744	4,216
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.