Information Collection

Acf-196r

IC 210064 under ICR 202106-0970-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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_Instructions_Non-Substantive Approval_CLEAN VERSION_6-28-21.docx	Instruction
ACF_196R_Instructions_Non-Substantive Approval_CLEAN VERSION_6-28-21.docx	Instruction
196R ACF-196R Form ACF_196R_form - TANF - Non-Substantive Approval_6-28-21.pdf	Form
196R ACF-196R Form ACF_196R_form - TANF - Non-Substantive Approval_6-28-21.pdf	Form
Form ACF-196R Instructions Draft July 2017.doc Instructions	IC Document
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	ACF-196R Form	ACF_196R_form - TANF - Non-Substantive Approval_6-28-21.pdf		Yes	Yes	Fillable Fileable
Instruction			ACF_196R_Instructions_Non-Substantive Approval_CLEAN VERSION_6-28-21.docx		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	Form ACF-196R Instructions Draft July 2017.doc	10/17/2017

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