Information Collection

Child Access and Visitation Grant Application Form

IC 221499 under ICR 202205-0970-012 · OMB 0970-0482.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Child Access and Visitation Grant Application Form	Form
1 AV Application AV Program Application - Application Form - with header and directions-5.16.22 clean.docx	Form
1 AV Application AV Program Application - Application Form - with header and directions-5.16.22 clean.docx	Form

IC Title:

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	AV Application	AV Program Application - Application Form - with header and directions-5.16.22 clean.docx		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: 54

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	54	54
Annual IC Time Burden (Hours)	540	540
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.