Information Collection

CFS-101, Parts I, II, and III

IC 184244 under ICR 202007-0970-002 · OMB 0970-0426.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0426 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CFS-101 Forms CFS-101, Parts I, II, and III	Form
0970-0426 CFS-101 Instructions _April 2020.docx	Instruction
CFS-101 Forms CFS-101 Forms 0970-0426 CFS-101 Forms - Clean.xlsx	Form

IC Title:

CFS-101, Parts I, II, and III

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 1357.15

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	CFS-101 Forms	CFS-101 Forms	0970-0426 CFS-101 Forms - Clean.xlsx		Yes	Yes	Fillable Fileable
Instruction			0970-0426 CFS-101 Instructions _April 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: 233

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	233	-9	242
Annual IC Time Burden (Hours)	1,165	-45	1,210
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.