Information Collection

YCC QPR Form

IC 214309 under ICR 201412-1291-001 · OMB 1291-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1291-0002 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment B_YCC QPR form 12 30 2014.xlsx	Other-YCC QPR Form

IC Title:

YCC QPR Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 29 CFR 95.51(b)

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
Other-YCC QPR Form			Attachment B_YCC QPR form 12 30 2014.xlsx		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: 24

Number of Respondents for Small Entity: 24

Affected Public: State, Local, and Tribal Governments

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	96	96
Annual IC Time Burden (Hours)	1,344	1,344
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.