Information Collection

Beneficiaries

IC 184626 under ICR 201709-0990-001 · OMB 0990-0330.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0330 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix C1. Introductory Letter-English.docx	Other-letter
Appendix C2. Introductory Letter-Spanish.docx	Other-letter
Appendix C3 Telephone Survey Introduction Script (English).docx	Other-survey
Appendix C5 Reminder Voicemail Script (English).docx	Other-script
Appendix C6 Reminder Voicemail Script (Spanish).docx	Other-script
Appendix C4 Telephone Survey Introduction Script (Spanish).docx	Other-script
Appendix C7. Reminder Letter with Mail Survey (English).docx	Other-survey
Appendix C8. Reminder Letter with Mail Survey (Spanish).docx	Other-survey
60-dayFederal Register, Volume 82 Issue 187 (Thursday, September 28, 2017).htm 60-day	IC Document
30-day Federal Register, Volume 82 Issue 247 (Wednesday, December 27, 2017).htm 30day	IC Document

IC Title:

Beneficiaries

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-letter	Appendix C1. Introductory Letter-English.docx	No	Paper Only
Other-letter	Appendix C2. Introductory Letter-Spanish.docx	No	Paper Only
Other-survey	Appendix C3 Telephone Survey Introduction Script (English).docx	No	Paper Only
Other-script	Appendix C5 Reminder Voicemail Script (English).docx	No	Paper Only
Other-script	Appendix C6 Reminder Voicemail Script (Spanish).docx	No	Paper Only
Other-script	Appendix C4 Telephone Survey Introduction Script (Spanish).docx	No	Paper Only
Other-survey	Appendix C7. Reminder Letter with Mail Survey (English).docx	No	Fillable Fileable
Other-survey	Appendix C8. Reminder Letter with Mail Survey (Spanish).docx	No	Paper Only

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	200	40	160
Annual IC Time Burden (Hours)	50	21	29
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
60-day	60-dayFederal Register, Volume 82 Issue 187 (Thursday, September 28, 2017).htm	01/26/2018
30day	30-day Federal Register, Volume 82 Issue 247 (Wednesday, December 27, 2017).htm	01/26/2018

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