Information Collection

Third Party Verification

IC 209158 under ICR 201311-2528-001 · OMB 2528-0203.

Documents and Forms

Document Name Document Type
Form TPVR1-16 Third Party Verification Form
TPVR1-16 Third Party Verification Reqest (TPVR) Appendix F2 - FY 2013 TPVR forms.pdf Form
Appendix F1 - Consent to Release Information Letter to Third Party.docx Consent to Release Information Letter to Third Party IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Third Party Verification	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	TPVR1-16	Third Party Verification Reqest (TPVR)	Appendix F2 - FY 2013 TPVR forms.pdf		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: 3,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 85 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Consent to Release Information Letter to Third Party	Appendix F1 - Consent to Release Information Letter to Third Party.docx	11/01/2013

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