Information Collection

Instrument 3 - Performance Reporting Data Entry Form

IC 236138 under ICR 202312-0970-001 · OMB 0970-0536.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0536 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Instrument 3 - Performance Reporting Data Entry Form	Form and Instruction
1 SRAE Performance Reporting System Data Entry Form Instrument 3_SRAE Performance Reporting System Data Entry Form_091321_clean.docx	Form and Instruction
1 SRAE Performance Reporting System Data Entry Form Instrument 3_SRAE Performance Reporting System Data Entry Form_091321_clean.docx	Form and Instruction

IC Title:

Instrument 3 - Performance Reporting Data Entry Form

Agency IC Tracking Number:

Is this a Common Form? No

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
Form and Instruction	1	SRAE Performance Reporting System Data Entry Form	Instrument 3_SRAE Performance Reporting System Data Entry Form_091321_clean.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: 192

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	384	384
Annual IC Time Burden (Hours)	6,144	6,144
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.