Information Collection

Request for Information

IC 217869 under ICR 201910-0970-001 · OMB 0970-0467.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0467 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Request for Information	Form and Instruction
1 Sample Instrument TVAP data Sample Instrument_TVAP data.docx	Form and Instruction

IC Title:

Request for Information

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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 and Instruction	1	Sample Instrument TVAP data	Sample Instrument_TVAP data.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: 1,250

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-1,250	1,250
Annual IC Time Burden (Hours)	-313	313
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.