Information Collection

Client Eligibility Documentation Form

IC 254744 under ICR 202207-2528-003 · OMB 2528-0335.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2528-0335 can be found here:

Documents and Forms

Document Name Document Type
Appendix B. Client Eligibility Documentation Form_OAHM_Final.docx Other-Client Eligibility Documentati

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Client Eligibility Documentation Form	Agency IC Tracking Number:

Is this a Common Form? No		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
Other-Client Eligibility Documentation Form			Appendix B. Client Eligibility Documentation Form_OAHM_Final.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,478	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,478	4,478
Annual IC Time Burden (Hours)	358	358
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.