Information Collection

Annex II: Acknowledgment from under Article 12(3)

IC 224027 under ICR 201612-0970-007 · OMB 0970-0488.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0488 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Annex II: Acknowledgment from under Article 12(3) Form and Instruction
1 Annex 2 Acknowledgement Annex_2_Acknowledgement.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Annex II: Acknowledgment from under Article 12(3)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Annex 2 Acknowledgement	Annex_2_Acknowledgement.pdf		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Previously Approved
Annual Number of Responses for this IC	5,022	5,022
Annual IC Time Burden (Hours)	2,511	2,511
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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