Information Collection

FFS Compliance and Safety Site Visit Report (Form M-3A) - Recordkeeping

IC 245576 under ICR 202108-0970-016 · OMB 0970-0564.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0564 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form M-3A FFS Compliance and Safety Site Visit Report (Form M-3A) - Recordkeeping	Form and Instruction
Form M-3A FFS Compliance and Safety Site Visit Report 02 - FFS Compliance and Safety Site Visit Report (Form M-3A).xlsx	Form and Instruction
Form M-3A FFS Compliance and Safety Site Visit Report 02 - FFS Compliance and Safety Site Visit Report (Form M-3A).xlsx	Form and Instruction

IC Title:

FFS Compliance and Safety Site Visit Report (Form M-3A) - Recordkeeping

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Mandatory

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
Form and Instruction	Form M-3A	FFS Compliance and Safety Site Visit Report	02 - FFS Compliance and Safety Site Visit Report (Form M-3A).xlsx		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: 4

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
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-28	28
Annual IC Time Burden (Hours)	-336	336
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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