Information Collection

EEOP short form

IC 205719 under ICR 201408-1121-008 · OMB 1121-0340.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
EEOP short form	Form
EEOP short form EEOP Short Form Screen Shots.pdf	Form

IC Title:

EEOP short form

Agency IC Tracking Number:

OCR

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	none	EEOP short form	EEOP Short Form Screen Shots.pdf	n/a	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,286

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	3,286	3,286
Annual IC Time Burden (Hours)	13,144	13,144
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.