OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Title X Outreach and Enrollment Report

IC 211642 under ICR 201412-0990-001 · OMB 0990-0423.

Documents and Forms
Document Name
Document Type
Other-Report
Information Collection (IC) Details

View Information Collection (IC)

Title X Outreach and Enrollment Report
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Report 0990-New_Title X outreach and enrollment sample data collection form.docx Yes Yes Fillable Printable

Health Health Care Services

 

4,200 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,200 0 0 0 0 4,200
Annual IC Time Burden (Hours) 840 0 0 0 0 840
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.