Information Collection

Access and Visitation Survey - States and Jurisdictions

IC 10033 under ICR 202403-0970-013 · OMB 0970-0204.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0204 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Access and Visitation Survey - States and Jurisdictions	Form
Access and Visitation Instruction Manual_12.22.23.docx	Instruction
Access and Visitation Instruction Manual_12.22.23.docx	Instruction
1 AV Survey Grantee or Subgrantee Collection Instrument 12.20.2023.xls	Form
1 AV Survey Grantee or Subgrantee Collection Instrument 12.20.2023.xls	Form

IC Title:

Access and Visitation Survey - States and Jurisdictions

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 303

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	1	AV Survey	Grantee or Subgrantee Collection Instrument 12.20.2023.xls		Yes	Yes	Fillable Printable
Instruction			Access and Visitation Instruction Manual_12.22.23.docx		Yes	Yes	Printable Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 53

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	53	-1	54
Annual IC Time Burden (Hours)	848	-16	864
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.