Information Collection

Community Relations Service Evaluation Form

IC 247477 under ICR 201911-1103-003 · OMB 1103-0117.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1103-0117 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1103-0117 CRS Evaluation Form Community Relations Service Evaluation Form	Form and Instruction
1103-0117 CRS Evaluation Form GEN IC Form - CRS Small Group TOF Evaluation Form 1103-0117.docx	Form and Instruction
Generic IC Template - CRS Small Group TOF Evaluation Form 1103-0117.pdf Template for GEN IC CRS Evaluation Form	IC Document

IC Title:

Community Relations Service Evaluation Form

Agency IC Tracking Number:

1103-0117

IC Status: New

Obligation to Respond: Voluntary

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	1103-0117				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: 120

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Template for GEN IC CRS Evaluation Form		05/18/2021

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].