Refusal of Temporary Assistance

U. S. Repatriation Program Forms

OMB: 0970-0474

IC ID: 218655

Information Collection (IC) Details

View Information Collection (IC)

Refusal of Temporary Assistance
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Refusal of Temporary Assistance Form HHS Repatriation Program - Refusal of Temporary Assistance Form.doc Yes Yes Fillable Printable

Community and Social Services Social Services

 

15 0
   
State, Local, and Tribal Governments
 
   100 %

  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 15 0 15 0 0 0
Annual IC Time Burden (Hours) 1 0 1 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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