Information Collection

Remote Video Inspection (RVI)

IC 250797 under ICR 202206-2577-001 · OMB 2577-0298.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Survey of Residents 063022.xlsx	Instruction
Survey of Residents 063022.xlsx	Instruction
Survey of Proxies 063022.xlsx	Instruction
Survey of Proxies 063022.xlsx	Instruction
INSPECTION CHECKLIST.pdf	Instruction
INSPECTION CHECKLIST.pdf	Instruction
50139 Disclosure Form Form 50139 Disclosure Form.docx	Form and Instruction
50139 Disclosure Form Form 50139 Disclosure Form.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Survey of Residents 063022.xlsx	Yes	Yes	Fillable Printable
Instruction			Survey of Proxies 063022.xlsx	Yes	Yes	Fillable Printable
Instruction			INSPECTION CHECKLIST.pdf	Yes	Yes	Fillable Printable
Form and Instruction	50139	Disclosure Form	Form 50139 Disclosure Form.docx	Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,604

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	6,604	5,386	1,218
Annual IC Time Burden (Hours)	1,499	1,199	300
Annual IC Cost Burden (Dollars)	0	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.