OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Transgender Women > 18 years old - Eligibility Screener

IC 234906 under ICR 202301-0920-002 · OMB 0920-1262.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
18 years old - Eligibility Screener Form and Instruction
Eligibility Screener (English)
Att 4a_Eligibility Screener (English).docx 		Form and Instruction
Eligibility Screener (English)
Att 4a_Eligibility Screener (English).docx 		Form and Instruction
Eligibility Screener (Spanish)
Att 5a_Eligibility Screener (Spanish).docx 		Form and Instruction
Eligibility Screener (Spanish)
Att 5a_Eligibility Screener (Spanish).docx 		Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 None Eligibility Screener (English) Att 4a_Eligibility Screener (English).docx Yes Yes Fillable Fileable
Form and Instruction None Eligibility Screener (Spanish) Att 5a_Eligibility Screener (Spanish).docx Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,540 0 0 0 0 1,540
Annual IC Time Burden (Hours) 128 0 0 0 0 128
Annual IC Cost Burden (Dollars) 0 0 0 0 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.