21st CCLC 4201(b)(1)(A) Waiver Request

21st CCLC 4201(b)(1) Waiver Request

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1810-0746 can be found here:

Documents and Forms

Document Name Document Type
21stCCLC_WaiverTemplate.docx Other-Waiver Template

Information Collection (IC) Details

IC Title:	21st CCLC 4201(b)(1)(A) Waiver Request	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Waiver Template			21stCCLC_WaiverTemplate.docx		Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 53	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	53	53
Annual IC Time Burden (Hours)	159	159
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.