Information Collection

Contact Information Update Request

IC 257428 under ICR 202212-0970-008 · OMB 0970-0574.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0574 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 5_Contact Information Update Request_20221216.docx	Other-Contact Form
Instrument 5_Contact Information Update Request_Clean_20230317.docx	Other-Contact Information Request

IC Title:

Contact Information Update Request

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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
Other-Contact Information Request			Instrument 5_Contact Information Update Request_Clean_20230317.docx		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: 350

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	466	466
Annual IC Time Burden (Hours)	37	37
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.