Information Collection

Annex F: Request for Specific Measures – Response - Article 7(1)

IC 257287 under ICR 202212-0970-004 · OMB 0970-0488.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0488 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Annex F: Request for Specific Measures – Response - Article 7(1)	Form and Instruction
1 Request for Specific Measures – Response Annex F Request for Specific Measures – Response - Article 7(1).pdf	Form and Instruction
1 Request for Specific Measures – Response Annex F Request for Specific Measures – Response - Article 7(1).pdf	Form and Instruction

IC Title:

Annex F: Request for Specific Measures â Response - Article 7(1)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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 and Instruction	1	Request for Specific Measures â Response	Annex F Request for Specific Measures â Response - Article 7(1).pdf		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: 54

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	432	432
Annual IC Time Burden (Hours)	73	73
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.