Client Characteristics and Program Entry

Domestic Victims of Human Trafficking (DVHT) Program Data

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0542 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Client Characteristics and Program Entry Form
OMB 0970-0542_Revised DVHT Reporting Reference Guide_10.17.22.docx Instruction
OMB 0970-0542_Revised DVHT Reporting Reference Guide_Clean_2.16.23.docx Instruction
1 Client Characteristics and Enrollment Form OMB 0970-0542_Revised DVHT Performance Indicators_10.17.22.docx Form
1 Client Characteristics and Program Entry Form OMB 0970-0542_Revised DVHT Performance Indicators_Clean_2.16.23.docx Form

Information Collection (IC) Details

IC Title:	Client Characteristics and Program Entry	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	1	Client Characteristics and Program Entry Form	OMB 0970-0542_Revised DVHT Performance Indicators_Clean_2.16.23.docx		Yes	Yes	Fillable Fileable
Instruction			OMB 0970-0542_Revised DVHT 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: 1,700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	567	-69	636
Annual IC Time Burden (Hours)	425	-211	636
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.