Information Collection

Acf-196r

IC 210064 under ICR 202103-0970-009 · OMB 0970-0446.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0446 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 196R ACF-196R Form ACF-196R	Form
ACF_196R_Instructions_Expedited Approval 3-19-21 Clean Version.docx	Instruction
196R ACF-196R Form acf_196r_form - TANF ARPA - Expedited Approval.xlsx	Form
Form ACF-196R Instructions Draft July 2017.doc Instructions	IC Document

IC Title:

ACF-196R

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 265

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	196R				Yes	Yes	Fillable Fileable
Instruction					Yes	No	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 51

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	204	204
Annual IC Time Burden (Hours)	2,856	2,856
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Instructions		10/17/2017

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

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