Information Collection

Notice to UAC for Flores Visits (Forms A-4 & A-4s)

IC 241070 under ICR 202109-0970-014 · OMB 0970-0547.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0547 can be found here:

Documents and Forms

Document Name Document Type
Form A-4 Notice to UAC for Flores Visits (Forms A-4 & A-4s) Form
A-4 Notice to UC for Flores Visits Notice to UC for Flores Visits - English (Form A-4) - PDF.pdf Form
A-4 Notice to UC for Flores Visits Notice to UC for Flores Visits (Form A-4).pdf Form
A-4s Notice to UC for Flores Visits - Spanish Notice to UC for Flores Visits (Form A-4s) - PDF.pdf Form
A-4s Notice to UC for Flores Visits - Spanish Notice to UC for Flores Visits (Form A-4s).pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Notice to UAC for Flores Visits (Forms A-4 & A-4s)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	A-4	Notice to UC for Flores Visits	Notice to UC for Flores Visits (Form A-4).pdf		Yes	Yes	Fillable Fileable
Form	A-4s	Notice to UC for Flores Visits - Spanish	Notice to UC for Flores Visits (Form A-4s).pdf		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.