Annex D: Application for Modification of a Decision, including Restricted Information on the Applicant

Provision of Child Support Services in IV-D cases under the Hague Child Support Convention

OMB: 0970-0488

IC ID: 224048

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Annex D: Application for Modification of a Decision, including Restricted Information on the Applicant
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Application for Modification of a Decision Annex D_Application_for_Modification_of_a_Decision OMB.docx Yes Yes Fillable Printable

Community and Social Services Social Services

 

54 0
   
State, Local, and Tribal Governments
 
   50 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 216 0 0 -54 0 270
Annual IC Time Burden (Hours) 108 0 0 -27 0 135
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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