Information Collection

Partnerships with Faith-Based and Other Neighborhood Organizations

IC 217481 under ICR 201507-1121-002 · OMB 1121-0353.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form XXXX Partnerships with Faith-Based and Other Neighborhood Organizations	Form and Instruction
XXXX Beneficiary Referral Request 1121-NEW NPRM_Beneficiary Request form_071515.doc	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 28 CFR Part 38 (To search for a specific CFR, visit the Code of Federal Regulations.)

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 and Instruction	XXXX	Beneficiary Referral Request	1121-NEW NPRM_Beneficiary Request form_071515.doc		Yes	Yes	Printable Only

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	150	150
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.