Information Collection

FFS Site Visit Form (Form M-3A) - Respondents

IC 245575 under ICR 202403-0970-014 · OMB 0970-0564.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form M-3A FFS Site Visit Form (Form M-3A) - Respondents	Form and Instruction
Form Form M-3A FFS Site Visit Form (Form M-3A) - Respondents	Form and Instruction
Form M-3A FFS Compliance and Safety Site Visit Report FFS Site Visit Form_2024 03 22.pdf	Form and Instruction
Form M-3A FFS Compliance and Safety Site Visit Report FFS Site Visit Form_2024 03 22.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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	Form M-3A	FFS Compliance and Safety Site Visit Report	FFS Site Visit Form_2024 03 22.pdf		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: 262

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	3,144	3,144
Annual IC Time Burden (Hours)	3,144	3,144
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.