Information Collection

Contact Form

IC 261520 under ICR 202403-0970-007 · OMB 0970-0616.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0616 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instr.2_Contact Form_clean.docx	Other-Contact Form
Instr.2_Contact Form_clean.docx	Other-Contact Form

IC Title:

Contact Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-Contact Form			Instr.2_Contact Form_clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title: OPRE Research and Evaluation Project Records

FR Citation: 87 FR 57198

Number of Respondents: 1,843

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,457	2,457
Annual IC Time Burden (Hours)	418	418
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.