Information Collection

302.33(a)(6)

IC 212708 under ICR 201408-0970-001 · OMB 0970-0451.

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Information Collection (IC) Details

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IC Title:	302.33(a)(6)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 302.33(a)(6)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 27	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	27	27
Annual IC Time Burden (Hours)	135,000	135,000
Annual IC Cost Burden (Dollars)	4,590,000	4,590,000

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