Request for Assistance for Child Victims of Human Trafficking

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0362 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Request for Assistance for Child Victims of Human Trafficking Form and Instruction
1 Request for Assistance Form Request for Assistance form.pdf Form and Instruction
ATIP Sex Trafficking Poster.pdf Sex Trafficking Poster IC Document
ATIP Social Services Migrant Poster.pdf ATIP Social Services Migrant Poster IC Document
Attachment A_TVPA U.S. Code cite authorizing collection of information.doc Attachment A_TVPA U IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request for Assistance for Child Victims of Human Trafficking	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Request for Assistance Form	Request for Assistance form.pdf		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	40	-160	200
Annual IC Time Burden (Hours)	40	-160	200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Sex Trafficking Poster	ATIP Sex Trafficking Poster.pdf	04/10/2009
ATIP Social Services Migrant Poster	ATIP Social Services Migrant Poster.pdf	04/10/2009
Attachment A_TVPA U	Attachment A_TVPA U.S. Code cite authorizing collection of information.doc	04/10/2009

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