Information Collection

Written Application for the Independent Living Services for Older Individuals Who are Blind Formula Grant

IC 21689 under ICR 202305-1820-003 · OMB 1820-0660.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Written Application for the Independent Living Services for Older Individuals Who are Blind Formula Grant	Form and Instruction
OIB Application Assurances OIB State Assurances 2023 with cover letter-updated 6.5.23.docx	Form and Instruction
OIB Application Assurances OIB State Assurances 2023 with cover letter-updated 6.5.23.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 34 CFR 367.4

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	NA	OIB Application Assurances	OIB State Assurances 2023 with cover letter-updated 6.5.23.docx		Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 19

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
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	19	-37	56
Annual IC Time Burden (Hours)	3	-6	9
Annual IC Cost Burden (Dollars)	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.