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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.