Notice of Lien

Administrative Subpoena and Notice of Interstate Lien

Documents and Forms

Document Name Document Type
Form 1 Notice of Lien Form and Instruction
1 Notice of Lien Notice of Lien - CLEAN.docx Form and Instruction
1 Notice of Lien Notice of Lien - CLEAN.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Notice of Lien	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Notice of Lien	Notice of Lien - CLEAN.docx		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,607,148	-179,820	1,786,968
Annual IC Time Burden (Hours)	803,574	-89,920	893,494
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.