Information Collection

State Department of Education Contacts Form

IC 245011 under ICR 202104-0970-004 · OMB 0970-0531.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0531 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
State Contacts Form-10-7-19 - clean.docx	Other-
Supporting Statement-State Department of Education Contacts Form-10-7-19 - clean.docx Supporting Statement A - State Department of Education Contacts Form	IC Document
NOA - OHS State Contacts - Program Support Generic_0970-0531_10.10.19.pdf NOA - State Department of Education Contacts Form	IC Document

IC Title:

State Department of Education Contacts Form

Agency IC Tracking Number:

IC Status: Unchanged

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
Other-			State Contacts Form-10-7-19 - 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: 54

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	54	54
Annual IC Time Burden (Hours)	54	54
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A - State Department of Education Contacts Form	Supporting Statement-State Department of Education Contacts Form-10-7-19 - clean.docx	12/21/2020
NOA - State Department of Education Contacts Form	NOA - OHS State Contacts - Program Support Generic_0970-0531_10.10.19.pdf	12/21/2020

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