Information Collection

Center for States Subscription Form

IC 234737 under ICR 201801-0970-013 · OMB 0970-0401.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0401 can be found here:

Documents and Forms

Document Name Document Type
CenterforStatesSubscriptionForm_1-17-19.docx Other-Subscription Form
CenterforStatesSubscriptionForm_Submission Form_1.18.19.doc Fast Track Submission Form - Center for States Subscription Form IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Center for States Subscription Form	Agency IC Tracking Number:	ACYF

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Subscription Form			CenterforStatesSubscriptionForm_1-17-19.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,223	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,223	1,223
Annual IC Time Burden (Hours)	61	61
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fast Track Submission Form - Center for States Subscription Form	CenterforStatesSubscriptionForm_Submission Form_1.18.19.doc	01/18/2019

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