Information Collection

Disability Funds Financial Assistance Application

IC 229087 under ICR 201711-1559-001 · OMB 1559-0048.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1559-0048 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2018-02 Disability Funds Financial Assistance Application	Form and Instruction
2018-02 Disability Funds Financial Assistance Application v2 Disability Funds Financial Assistance Application Questions - 2.7.18 Revision.docx	Form and Instruction

IC Title:

Disability Funds Financial Assistance Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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 and Instruction	2018-02	Disability Funds Financial Assistance Application v2	Disability Funds Financial Assistance Application Questions - 2.7.18 Revision.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	360	360
Annual IC Cost Burden (Dollars)	21,074	21,074

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.