Information Collection

Annual Data Report (ADR)

IC 220434 under ICR 202202-0970-009 · OMB 0970-0475.

Documents and Forms

Document Name Document Type
Form 1 Annual Data Report (ADR) Form
ADR Instructions.pdf Instruction
ADR Instructions.pdf Instruction
Guidance SEEDS Business and RevenueTrackingFINAL.pdf Instruction
Guidance SEEDS Business and RevenueTrackingFINAL.pdf Instruction
Guidance SEEDS Employment TrackingFINAL.pdf Instruction
Guidance SEEDS Employment TrackingFINAL.pdf Instruction
1 Annual Data Report ADR FINAL.pdf Form
1 Annual Data Report ADR FINAL.pdf Form
1 SEEDS SEEDS Data Collection ResourceFINAL.xlsx Form
1 SEEDS SEEDS Data Collection ResourceFINAL.xlsx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Annual Data Report (ADR)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Annual Data Report	ADR FINAL.pdf	Yes	Yes	Fillable Printable
Instruction			ADR Instructions.pdf	Yes	Yes	Fillable Printable
Form	1	SEEDS	SEEDS Data Collection ResourceFINAL.xlsx	Yes	Yes	Fillable Printable
Instruction			Guidance SEEDS Business and RevenueTrackingFINAL.pdf	Yes	Yes	Fillable Printable
Instruction			Guidance SEEDS Employment TrackingFINAL.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: 80	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	80	-195	275
Annual IC Time Burden (Hours)	80	-195	275
Annual IC Cost Burden (Dollars)	0	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.