Information Collection

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

IC 9787 under ICR 201712-0970-003 · OMB 0970-0004.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.