Annual Statistical Report on Children in Foster Homes and in Families Receiving Payments in Excess of the Poverty Income Level from a State Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0004 can be found here:

Documents and Forms

Document Name Document Type
Form ACF 4125 Annual Statistical Report on Children in Foster Homes and in Families Receiving Payments in Excess of the Poverty Income Level from a State Program Form
ACF4125 INSTR.pdf Instruction
ACF 4125 Annual Statistical Report on Children in Foster Homes an Copy of 17formall.xls Form
pi_acf_4125fy2017_signed.pdf PI IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Annual Statistical Report on Children in Foster Homes and in Families Receiving Payments in Excess of the Poverty Income Level from a State Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 5 CFR 1320 1 CFR 1124

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	ACF 4125	Annual Statistical Report on Children in Foster Homes and in Families Receiving Payments in Excess of the Poverty Income Level from a State Program	Copy of 17formall.xls		Yes	Yes	Fillable Printable
Instruction			ACF4125 INSTR.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: 52	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 60 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	52	52
Annual IC Time Burden (Hours)	13,746	13,746
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
PI	pi_acf_4125fy2017_signed.pdf	03/27/2018

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