Information Collection

Staff reports of program service receipt

IC 227922 under ICR 202204-0970-008 · OMB 0970-0506.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment G Staff Reports of Program Receipt_v9_Part 1_clean.DOC	Other-Staff reports
Attachment G Staff Reports of Program Receipt_v9_Part 1_clean.DOC	Other-Staff reports
Attachment G Staff Reports of Program Receipt_v7_Part 2.pdf Attachment G Staff Reports of Program Receipt - Screen Shots	IC Document
Attachment G Staff Reports of Program Receipt_v7_Part 2.pdf Attachment G Staff Reports of Program Receipt - Screen Shots	IC Document

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
Other-Staff reports			Attachment G Staff Reports of Program Receipt_v9_Part 1_clean.DOC		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: 20

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
	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	0	0	0	0	0	104,000
Annual IC Time Burden (Hours)	0	0	0	0	0	3,120
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment G Staff Reports of Program Receipt - Screen Shots	Attachment G Staff Reports of Program Receipt_v7_Part 2.pdf	04/05/2018

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