Information Collection

Child Access and Visitation Grant Application Form

IC 221499 under ICR 201904-0970-005 · OMB 0970-0482.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0482 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Child Access and Visitation Grant Application Form	Form
1 AV Application Attachment A AV Program Application - Application Form - FINAL.docx	Form
AV Program Application Memo Instructions - final.docx Access and Visitation Program Application Memo and Instructions	IC Document

IC Title:

Child Access and Visitation Grant Application Form

Agency IC Tracking Number:

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	1	AV Application	Attachment A AV Program Application - Application Form - FINAL.docx		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: 54

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	54	54
Annual IC Time Burden (Hours)	540	540
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Access and Visitation Program Application Memo and Instructions	AV Program Application Memo Instructions - final.docx	04/18/2019

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