Information Collection

Monthly Enrollment

IC 198342 under ICR 202012-0970-012 · OMB 0970-0427.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0427 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Monthly Enrollment	Form and Instruction
1 Monthly Enrollment 0970-0427-Instrument-Monthly Enrollment-2020-Clean.docx	Form and Instruction

IC Title:

Monthly Enrollment

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	1	Monthly Enrollment	0970-0427-Instrument-Monthly Enrollment-2020-Clean.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: 2,160

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	25,920	25,920
Annual IC Time Burden (Hours)	1,296	1,296
Annual IC Cost Burden (Dollars)	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.