Information Collection

303.72

IC 212731 under ICR 201408-0970-001 · OMB 0970-0451.

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Information Collection (IC) Details

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IC Title:	303.72	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 303.72

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: 54	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	54	54
Annual IC Time Burden (Hours)	27,000	27,000
Annual IC Cost Burden (Dollars)	918,000	918,000

Documents for IC

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