Information Collection

Participant Contact Information Form

IC 202225 under ICR 201506-0970-017 · OMB 0970-0413.

Documents and Forms

Document Name Document Type
Appendix_C_Contact Information Form 10-3-12.doc Other-Contact Info Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Participant Contact Information Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Contact Info Form			Appendix_C_Contact Information Form 10-3-12.doc		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: 2,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,600	933	1,667
Annual IC Time Burden (Hours)	208	75	133
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.