Information Collection

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

IC 9787 under ICR 202103-0970-005 · OMB 0970-0004.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

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.