Information Collection

Brief Agency Contacts

IC 213523 under ICR 201409-0970-004 · OMB 0970-0123.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Brief Agency Contacts	Form and Instruction
1 Data Measures 2014 RHYMIS 3 0 Data Measures_Final.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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 and Instruction	1	Data Measures	2014 RHYMIS 3 0 Data Measures_Final.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: 664

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	574,360	574,360
Annual IC Time Burden (Hours)	28,718	28,718
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.