Information Collection

2017 SPPA Pilot Instrument

IC 220634 under ICR 202108-3135-001 · OMB 3135-0136.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 2017 SPPA Pilot Instrument	Form and Instruction
2 SPPA Pilot Instrument SPPA2017 Pilot_4 12 16-FINAL.docx	Form and Instruction
2 SPPA Pilot Instrument SPPA2017 Pilot_4 12 16-FINAL.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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
Form and Instruction	2	SPPA Pilot Instrument	SPPA2017 Pilot_4 12 16-FINAL.docx		No		Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-200	200
Annual IC Time Burden (Hours)	-33	33
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.