Information Collection

Survey of Victim Services Organizations Receiving Funds under Grant Programs Authorized under the Violence Against Women Act

IC 214765 under ICR 201501-1122-004 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1122-XXXX Survey of Victim Services Organizations Receiving Funds under Grant Programs Authorized under the Violence Against Women Act	Form
1122-XXXX Survey of Victim Services Organizations Receiving Funds TI SURVEY 1 26 15 (2).docx	Form
vawa.pdf VAWA	IC Document
vawa2000.pdf VAWA 2000	IC Document
vawa2005.pdf VAWA 2005	IC Document
VAWA13.pdf VAWA 2013	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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	1122-XXXX	Survey of Victim Services Organizations Receiving Funds under Grant Programs Authorized under the Violence Against Women Act	TI SURVEY 1 26 15 (2).docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 800

Number of Respondents for Small Entity: 800

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	267	267
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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