Information Collection

Special Evaluation Assistance for Rural Communities & Household

IC 223571 under ICR 201609-0505-001 · OMB 0505-0025.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0505-0025 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Place holder for AD 3030 Series Forms.docx	Other-Place Holder

IC Title:

Special Evaluation Assistance for Rural Communities & Household

Agency IC Tracking Number:

0572-0146 - State

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
Other-Place Holder			Place holder for AD 3030 Series Forms.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6	6
Annual IC Time Burden (Hours)	2	2
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.