Information Collection

Local Directors/Regional Representaitves and Local Representatives

IC 224905 under ICR 201612-0985-003 · OMB 0985-0055.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0985-0055 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Local Directors/Regional Representaitves and Local Representatives	Form
1 Local Director Survey Local-Directors-Survey.doc	Form
2 Local Representatives Survey Local-Representatives-Survey.doc	Form

IC Title:

Local Directors/Regional Representaitves and Local Representatives

Agency IC Tracking Number:

Is this a Common Form? No

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
Form	1	Local Director Survey	Local-Directors-Survey.doc		Yes	Yes	Fillable Fileable
Form	2	Local Representatives Survey	Local-Representatives-Survey.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: 300

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	300	300
Annual IC Time Burden (Hours)	175	175
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.