Information Collection

CJRP- JRFC Pilot Test

IC 263914 under ICR 202311-1121-004 · OMB 1121-0360.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0360 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
1121-0360 AppendixE-JFRC_Instrument.docx	Other-
1121-0360 AppendixE-JFRC_Instrument.docx	Other-
1121-0360 AppendixD-CJRP_Instrument_Revised.docx	Other-
1121-0360 AppendixD-CJRP_Instrument_Revised.docx	Other-
AppendixG-IRB_PrivacyCertificate (2).pdf Appendix G Privacy Certificate	IC Document
AppendixG-IRB_PrivacyCertificate (2).pdf Appendix G Privacy Certificate	IC Document
AppendixF-Confidentiality.pdf Appendix F- Confidentiality	IC Document
AppendixF-Confidentiality.pdf Appendix F- Confidentiality	IC Document
AppendixC-ExternalConsultants.docx Appendix C- External Consultants	IC Document
AppendixC-ExternalConsultants.docx Appendix C- External Consultants	IC Document
AppendixB-Contact_Materials-OMB_Revised (1).docx Appendix B	IC Document
AppendixB-Contact_Materials-OMB_Revised (1).docx Appendix B	IC Document
OMB Memo - CJRP- JRFC Pilot Test-OMB_Revised (1).docx Test Pilot	IC Document
OMB Memo - CJRP- JRFC Pilot Test-OMB_Revised (1).docx Test Pilot	IC Document
AppendixA-Acts (2).pdf Appendix A- Acts	IC Document
AppendixA-Acts (2).pdf Appendix A- Acts	IC Document
GEN IC (1121-0360) - CJRP- JRFC Pilot Test (1).docx 1121-0360 Gen IC	IC Document
GEN IC (1121-0360) - CJRP- JRFC Pilot Test (1).docx 1121-0360 Gen IC	IC Document

IC Title:

CJRP- JRFC Pilot Test

Agency IC Tracking Number:

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-			1121-0360 AppendixE-JFRC_Instrument.docx		Yes	Yes	Fillable Fileable
Other-			1121-0360 AppendixD-CJRP_Instrument_Revised.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: 360

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	360	360
Annual IC Time Burden (Hours)	1,026	1,026
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix G Privacy Certificate	AppendixG-IRB_PrivacyCertificate (2).pdf	12/13/2023
Appendix F- Confidentiality	AppendixF-Confidentiality.pdf	12/13/2023
Appendix C- External Consultants	AppendixC-ExternalConsultants.docx	12/13/2023
Appendix B	AppendixB-Contact_Materials-OMB_Revised (1).docx	12/13/2023
Test Pilot	OMB Memo - CJRP- JRFC Pilot Test-OMB_Revised (1).docx	12/13/2023
Appendix A- Acts	AppendixA-Acts (2).pdf	12/13/2023
1121-0360 Gen IC	GEN IC (1121-0360) - CJRP- JRFC Pilot Test (1).docx	12/13/2023

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