Information Collection

Annual Data Report (ADR)

IC 220434 under ICR 201808-0970-010 · OMB 0970-0475.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0475 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Annual Data Report (ADR)	Form
ADR Instructions.pdf	Instruction
Guidance SEEDS Business and RevenueTrackingFINAL.pdf	Instruction
Guidance SEEDS Employment TrackingFINAL.pdf	Instruction
1 Annual Data Report ADR FINAL.pdf	Form
1 SEEDS SEEDS Data Collection ResourceFINAL.xlsx	Form

IC Title:

Annual Data Report (ADR)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Annual Data Report	ADR FINAL.pdf	Yes	Yes	Fillable Printable
Instruction			ADR Instructions.pdf	Yes	Yes	Fillable Printable
Form	1	SEEDS	SEEDS Data Collection ResourceFINAL.xlsx	Yes	Yes	Fillable Printable
Instruction			Guidance SEEDS Business and RevenueTrackingFINAL.pdf	Yes	Yes	Fillable Printable
Instruction			Guidance SEEDS Employment TrackingFINAL.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: 275

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	275	275
Annual IC Time Burden (Hours)	275	275
Annual IC Cost Burden (Dollars)	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.