Barriers to Service Delivery and Monitoring Form

Trafficking Victim Assistance Program (TVAP) Data

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0467 can be found here:

Documents and Forms

Document Name Document Type
Form 4 Barriers to Service Delivery and Monitoring Form Form
OMB 0970-0467_Revised TVAP Reporting Reference Guide_10.17.22.docx Instruction
OMB 0970-0467_Revised TVAP Reporting Reference Guide_Clean_2.16.23.docx Instruction
4 Barriers to Service Delivery and Monitoring Form OMB 0970-0467_Revised TVAP Performance Indicators_10.17.22_Clean.docx Form
4 Barriers to Service Delivery and Monitoring Form OMB 0970-0467_Revised TVAP Performance Indicators_Clean_2.16.23.docx Form

Information Collection (IC) Details

IC Title:	Barriers to Service Delivery and Monitoring Form	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	4	Barriers to Service Delivery and Monitoring Form	OMB 0970-0467_Revised TVAP Performance Indicators_Clean_2.16.23.docx		Yes	Yes	Fillable Fileable
Instruction			OMB 0970-0467_Revised TVAP Reporting Reference Guide_Clean_2.16.23.docx		Yes	Yes	Printable Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 386	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	515	-790	1,305
Annual IC Time Burden (Hours)	86	-132	218
Annual IC Cost Burden (Dollars)	0	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.