Information Collection

Third Party Verification

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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
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 %

table that charts list of burden
	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

table that charts IC Documents
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.