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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.