Information Collection

Ocse-21-u4

IC 182889 under ICR 202003-0970-014 · OMB 0970-0017.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0017 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OCSE 21-U4 OCSE-21-U4	Form and Instruction
OCSE 21-U4 State Plan Transmittal Form OCSE 21-U4 (State Plan Transmittal Form)_final for OMB v2.docx	Form and Instruction

IC Title:

OCSE-21-U4

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 302.a

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	OCSE 21-U4	State Plan Transmittal Form	OCSE 21-U4 (State Plan Transmittal Form)_final for OMB v2.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: 54

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	648	378	270
Annual IC Time Burden (Hours)	162	94	68
Annual IC Cost Burden (Dollars)	0	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.