Information Collection

DVHT Spending Form

IC 239405 under ICR 202001-0970-006 · OMB 0970-0542.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0542 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 5 DVHT Spending Form	Form
5 DVHT Spending Form 5 - OTIP-0564 - DVHT New - DVHT Spending Form CLEAN.xlsx	Form
DVHT Grantee Reporting Reference Guide_1.21.20.docx DVHT Grantee Reporting Reference Guide	IC Document

IC Title:

DVHT Spending Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	5	DVHT Spending Form	5 - OTIP-0564 - DVHT New - DVHT Spending Form CLEAN.xlsx		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: 36

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	36	36
Annual IC Time Burden (Hours)	27	27
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
DVHT Grantee Reporting Reference Guide	DVHT Grantee Reporting Reference Guide_1.21.20.docx	01/23/2020

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