Information Collection

New Instrument #3: Performance Reporting System Data Entry Form

IC 207452 under ICR 201306-0970-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
New Instrument # 3 - Performance Reporting System Data Entry Form_CPREP.docx	Other-PRS Form

IC Title:

New Instrument #3: 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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-PRS Form			New Instrument # 3 - Performance Reporting System Data Entry Form_CPREP.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: 12

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	24	24
Annual IC Time Burden (Hours)	469	469
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.