Information Collection

Annual State Application Under Part B of the Individuals with Disabilities Act as Amended in 2004

IC 188619 under ICR 202210-1820-001 · OMB 1820-0030.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1820-0030 can be found here:

Documents and Forms

Document Name Document Type
Annual State Application Under Part B of the Individuals with Disabilities Act as Amended in 2004 Form
1820-0030-PartB-Instruct2023-9-7-22.docx Instruction
1820-0030-PartB-Instruct2023-9-7-22.docx Instruction
Significant Disproportionality Reporting Form 1820-0030-Section V.B. - Significant Disproportionality Form (PDF).pdf Form
Significant Disproportionality Reporting Form 1820-0030-Section V.B. - Significant Disproportionality Form (PDF).pdf Form
Application 1820-0030-PartB-App2023-9-7-22.docx Form
Application 1820-0030-PartB-App2023-9-7-22.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Annual State Application Under Part B of the Individuals with Disabilities Act as Amended in 2004	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 34 CFR 300.647(b)(1)(i) 34 CFR 300.705 34 CFR 300.640-645 34 CFR 300.646(a)(b) 34 CFR 300.100-176 34 CFR 300.199

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	N/A	Significant Disproportionality Reporting Form	1820-0030-Section V.B. - Significant Disproportionality Form (PDF).pdf	Yes	Yes	Fillable Fileable
Instruction			1820-0030-PartB-Instruct2023-9-7-22.docx	Yes	Yes	Fillable Fileable
Form	N/A	Application	1820-0030-PartB-App2023-9-7-22.docx	Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	2,340	2,340
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.