Information Collection

Family Violence Prevention Service Program Disaster Information Collection Form

IC 253535 under ICR 202207-0970-008 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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
FVPSP Disaster Info Collection Submission Form.docx GenIC - Family Violence Prevention Service Program Disaster Information Collection Form	IC Document

IC Title:

Family Violence Prevention Service Program Disaster Information Collection Form

Agency IC Tracking Number:

IC Status: Unchanged

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
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 %

table that charts list of burden
	Requested	Previously Approved
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

table that charts IC Documents
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.