Information Collection

Staff reports of program service receipt

IC 227922 under ICR 201804-0970-001 · OMB 0970-0506.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0506 can be found here:

Documents and Forms

Document Name Document Type
Attachment G Staff Reports of Program Receipt_v9_Part 1_clean.DOC Other-Staff reports
Attachment G Staff Reports of Program Receipt_v7_Part 2.pdf Attachment G Staff Reports of Program Receipt - Screen Shots IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Staff reports of program service receipt	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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-Staff reports			Attachment G Staff Reports of Program Receipt_v9_Part 1_clean.DOC		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: 10	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: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	52,000	52,000
Annual IC Time Burden (Hours)	1,560	1,560
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment G Staff Reports of Program Receipt - Screen Shots	Attachment G Staff Reports of Program Receipt_v7_Part 2.pdf	04/05/2018

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