Information Collection

Baseline information form for participants (Attachment D)

IC 235592 under ICR 202002-0970-007 · OMB 0970-0537.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0537 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
BEES _NonSub Change Request_Attachment D-Generic BIF CLEAN_Feb 2020.docx	Other-Standard BIF
BEES_NonSub Change Request_Attachment D-1-ARC BIF CLEAN_Feb 2020.docx	Other-Tailored BIF - ARC Site

IC Title:

Baseline information form for participants (Attachment D)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Other-Standard BIF			BEES _NonSub Change Request_Attachment D-Generic BIF CLEAN_Feb 2020.docx		Yes	Yes	Fillable Fileable
Other-Tailored BIF - ARC Site			BEES_NonSub Change Request_Attachment D-1-ARC BIF CLEAN_Feb 2020.docx		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: 4,133

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	Previously Approved
Annual Number of Responses for this IC	4,133	4,133
Annual IC Time Burden (Hours)	1,034	1,034
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.