Client Service Use and Delivery Form

Domestic Victims of Human Trafficking Program Data

OMB: 0970-0542

IC ID: 239401

Information Collection (IC) Details

View Information Collection (IC)

Client Service Use and Delivery Form
 
No Unchanged
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 2 Client Service Use and Delivery Form 2 - OTIP-0564 - DVHT New - Client Service Use and Delivery Form CLEAN.pdf Yes Yes Fillable Fileable

Community and Social Services Social Services

 

1,908 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,908 0 0 0 0 1,908
Annual IC Time Burden (Hours) 477 0 0 0 0 477
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
DVHT Grantee Reporting Reference Guide DVHT Grantee Reporting Reference Guide_1.21.20.docx 01/23/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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