Information Collection

Family Violence Prevention Service Program Disaster Information Collection Form

IC 253535 under ICR 202205-0970-008 · OMB 0970-0476.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0476 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Family Violence Prevention Service Program Disaster Information Collection Form Form
1 Family Violence Prevention Service Program Disaster Info FVPSP Disaster Info Collection Instrument_clean_02222022.docx Form
1 Family Violence Prevention Service Program Disaster Info FVPSP Disaster Info Collection Instrument_clean_02222022.docx Form
FVPSP Disaster Info Collection Submission Form.docx GenIC - Family Violence Prevention Service Program Disaster Information Collection Form IC Document
FVPSP Disaster Info Collection Submission Form.docx GenIC - Family Violence Prevention Service Program Disaster Information Collection Form IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Family Violence Prevention Service Program Disaster Information Collection Form	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Family Violence Prevention Service Program Disaster Information Collection Form	FVPSP Disaster Info Collection Instrument_clean_02222022.docx		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: 10	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
GenIC - Family Violence Prevention Service Program Disaster Information Collection Form	FVPSP Disaster Info Collection Submission Form.docx	05/16/2022

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