Information Collection

Title IV-E Tribal-State Agreement Evaluation

IC 257039 under ICR 202302-0970-002 · OMB 0970-0531.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0531 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Title_IV-E_Tribal_State_IV-E_Survey 11_18_22.docx	Other-Survey
Title_IV-E_Tribal_State_IV-E_Survey 11_18_22.docx	Other-Survey
SSA Form for Supplemental IV-E Project for Formative - OMB Part 1 11_21_22.docx SSA Form for Supplemental IV-E Project for Formative	IC Document
SSA Form for Supplemental IV-E Project for Formative - OMB Part 1 11_21_22.docx SSA Form for Supplemental IV-E Project for Formative	IC Document
SSB Form for Supplemental IV-E Project for Formative - OMB Form 11_18_22_SD.docx SSB Form for Supplemental IV-E Project for Formative	IC Document
SSB Form for Supplemental IV-E Project for Formative - OMB Form 11_18_22_SD.docx SSB Form for Supplemental IV-E Project for Formative	IC Document

IC Title:

Title IV-E Tribal-State Agreement Evaluation

Agency IC Tracking Number:

IC Status: Unchanged

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-Survey			Title_IV-E_Tribal_State_IV-E_Survey 11_18_22.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: 40

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA Form for Supplemental IV-E Project for Formative	SSA Form for Supplemental IV-E Project for Formative - OMB Part 1 11_21_22.docx	11/21/2022
SSB Form for Supplemental IV-E Project for Formative	SSB Form for Supplemental IV-E Project for Formative - OMB Form 11_18_22_SD.docx	11/21/2022

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