Information Collection

CJRP- JRFC Pilot Test

IC 245907 under ICR 202010-1121-004 · OMB 1121-0360.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0360 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1121-0360 CJRP- JRFC Pilot Test	Form and Instruction
1121-0360 Appendix D: CJRP Questionnaire AppendixD-CJRP_Instrument_Revised.docx	Form and Instruction
1121-0360 Appendix E: JRFC Questionnaire AppendixE-JFRC_Instrument_Revised.docx	Form and Instruction
OMB Memo - CJRP- JRFC Pilot Test-OMB_Revised.docx OMB Memo	IC Document
OMB Memo - CJRP- JRFC Pilot Test-OMB_Revised_TRACKED.docx OMB Memo Tracked Changes	IC Document
GEN IC (1121-0360) - CJRP- JRFC Pilot Test.docx GEN IC Template	IC Document
AppendixA-Acts.pdf Appendix A	IC Document
AppendixB-Contact_Materials-OMB_Revised.docx Appendix B	IC Document
AppendixC-ExternalConsultants.docx Appendix C	IC Document
AppendixF-Confidentiality.pdf Appendix F	IC Document
AppendixG-IRB_PrivacyCertificate.pdf Appendix G	IC Document

IC Title:

CJRP- JRFC Pilot Test

Agency IC Tracking Number:

1121-0360

IC Status: New

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
Form and Instruction	1121-0360	Appendix D: CJRP Questionnaire	AppendixD-CJRP_Instrument_Revised.docx		Yes	Yes	Fillable Fileable
Form and Instruction	1121-0360	Appendix E: JRFC Questionnaire	AppendixE-JFRC_Instrument_Revised.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: 360

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	360	360
Annual IC Time Burden (Hours)	1,026	1,026
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Memo	OMB Memo - CJRP- JRFC Pilot Test-OMB_Revised.docx	02/19/2021
OMB Memo Tracked Changes	OMB Memo - CJRP- JRFC Pilot Test-OMB_Revised_TRACKED.docx	02/19/2021
GEN IC Template	GEN IC (1121-0360) - CJRP- JRFC Pilot Test.docx	02/19/2021
Appendix A	AppendixA-Acts.pdf	02/19/2021
Appendix B	AppendixB-Contact_Materials-OMB_Revised.docx	02/19/2021
Appendix C	AppendixC-ExternalConsultants.docx	02/19/2021
Appendix F	AppendixF-Confidentiality.pdf	02/19/2021
Appendix G	AppendixG-IRB_PrivacyCertificate.pdf	02/19/2021

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.