Information Collection

Semi-annual Progress Report for Safe Havens: Supervised Visitation and Safe Exchange Grant Program

IC 12647 under ICR 201712-1122-007 · OMB 1122-0009.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1122-0009 Semi-annual Progress Report for Safe Havens: Supervised Visitation and Safe Exchange Grant Program	Form
1122-0009 Semi Annual Progress Report for Supervised Visitation Pr SafeHavensFormGMSSample2014.docx www.gms.gov	Form

IC Title:

Agency IC Tracking Number:

1122-0009

Is this a Common Form? No

IC Status: Modified

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	1122-0009	Semi Annual Progress Report for Supervised Visitation Program	SafeHavensFormGMSSample2014.docx	www.gms.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6

Number of Respondents for Small Entity: 6

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	12	-54	66
Annual IC Time Burden (Hours)	12	-54	66
Annual IC Cost Burden (Dollars)	0	0	0

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.