Information Collection

Refusal of Temporary Assistance

IC 218658 under ICR 202304-0970-011 · OMB 0970-0474.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0474 can be found here:

2026-02-17 - No material or nonsubstantive change to a currently approved collection
2025-02-13 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RR-06 Refusal of Temporary Assistance	Form and Instruction
Form RR-06 Refusal of Temporary Assistance	Form and Instruction
RR-06 Refusal of Temporary Assistance RR-06 Refusal of Temporary Assistance (1).docx	Form and Instruction
RR-06 Refusal of Temporary Assistance RR-06 Refusal of Temporary Assistance (1).docx	Form and Instruction
RR-06 Refusal of Temporary Assistance - Arabic RR-06 Refusal of Temporary Assistance - STANDARD_ar 508.pdf	Form and Instruction
RR-06 Refusal of Temporary Assistance - Arabic RR-06 Refusal of Temporary Assistance - STANDARD_ar 508.pdf	Form and Instruction
RR-06 Refusal of Temporary Assistance - French RR-06 Refusal of Temporary Assistance - STANDARD_fr 508.pdf	Form and Instruction
RR-06 Refusal of Temporary Assistance - French RR-06 Refusal of Temporary Assistance - STANDARD_fr 508.pdf	Form and Instruction
RR-06 Refusal of Temporary Assistance - Russian RR-06 Refusal of Temporary Assistance - STANDARD_ru 508.pdf	Form and Instruction
RR-06 Refusal of Temporary Assistance - Russian RR-06 Refusal of Temporary Assistance - STANDARD_ru 508.pdf	Form and Instruction
RR-06 Refusal of Temporary Assistance - Simplified Chinese RR-06 Refusal of Temporary Assistance - STANDARD_zh_cn 508.pdf	Form and Instruction
RR-06 Refusal of Temporary Assistance - Simplified Chinese RR-06 Refusal of Temporary Assistance - STANDARD_zh_cn 508.pdf	Form and Instruction
RR-06 Refusal of Temporary Assistance - Spanish RR-06 Refusal of Temporary Assistance - STANDARD_es_508.pdf	Form and Instruction
RR-06 Refusal of Temporary Assistance - Spanish RR-06 Refusal of Temporary Assistance - STANDARD_es_508.pdf	Form and Instruction
RR-06 Refusal of Temporary Assistance - Traditional Chinese RR-06 Refusal of Temporary Assistance - STANDARD_zh_TW 508.pdf	Form and Instruction
RR-06 Refusal of Temporary Assistance - Traditional Chinese RR-06 Refusal of Temporary Assistance - STANDARD_zh_TW 508.pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Refusal of Temporary Assistance

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	RR-06	Refusal of Temporary Assistance	RR-06 Refusal of Temporary Assistance (1).docx	Yes	Yes	Fillable Printable
Form and Instruction	RR-06	Refusal of Temporary Assistance - Arabic	RR-06 Refusal of Temporary Assistance - STANDARD_ar 508.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	RR-06	Refusal of Temporary Assistance - French	RR-06 Refusal of Temporary Assistance - STANDARD_fr 508.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	RR-06	Refusal of Temporary Assistance - Russian	RR-06 Refusal of Temporary Assistance - STANDARD_ru 508.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	RR-06	Refusal of Temporary Assistance - Simplified Chinese	RR-06 Refusal of Temporary Assistance - STANDARD_zh_cn 508.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	RR-06	Refusal of Temporary Assistance - Spanish	RR-06 Refusal of Temporary Assistance - STANDARD_es_508.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	RR-06	Refusal of Temporary Assistance - Traditional Chinese	RR-06 Refusal of Temporary Assistance - STANDARD_zh_TW 508.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	15	15
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.