7 Partnership Development Exit form

OMB Control Number: 0970-0467
Expiration Date: 11/30/2018

Trafficking Victim Assistance Program Grantee
Partnership Development and Expansion: Exit Form
Complete this form every time a partner is disenrolled form the grantee's network.
Grantee:
Reporting Period Start Date

Reporting Period End Date

Report Type

Name of Partner Organization/Agency

City

State or Territory

Disenrollment Date

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)
Public reporting burden for this collection of information is estimated to average .083 hours per response, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a currently valid OMB control number.