Annual Report on Children in Foster Homes and in Families Receiving Payments in Excess of the Poverty Income Level from a State Program

Annual Report on Children in Foster Homes and Children in Families Receiving Payment in Excess of the Poverty Income Level from a State Program Funded Under Part A of Title IV o (ACF-4125)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0004 can be found here:

Documents and Forms

Document Name Document Type
Form ACF 4125 Annual Report on Children in Foster Homes and in Families Receiving Payments in Excess of the Poverty Income Level from a State Program Form
ACF 4125 instructions - clean.docx Instruction
ACF 4125 instructions - clean.docx Instruction
ACF 4125 Annual Report on Children in Foster Homes and in Familie ACF-4125 form.xlsx Form
ACF 4125 Annual Report on Children in Foster Homes and in Familie ACF-4125 form.xlsx Form

Information Collection (IC) Details

IC Title:	Annual Report on Children in Foster Homes and in Families Receiving Payments in Excess of the Poverty Income Level from a State Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 5 CFR 1320 1 CFR 1124

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			ACF 4125 instructions - clean.docx		Yes	Yes	Fillable Printable
Form	ACF 4125	Annual Report on Children in Foster Homes and in Families Receiving Payments in Excess of the Poverty Income Level from a State Program	ACF-4125 form.xlsx		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 52	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 60 %

	Approved	Previously Approved
Annual Number of Responses for this IC	52	52
Annual IC Time Burden (Hours)	13,746	13,746
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.