Information Collection

Request for Appeal of Risk Determination Hearing (Form RDH-5)

IC 267483 under ICR 202405-0970-004 · OMB 0970-0633.

Documents and Forms

Document Name Document Type
Form RDH-5 Request for Appeal of Risk Determination Hearing (Form RDH-5) Form and Instruction
RDH-5 Request for Appeal of Risk Determination Hearing Request for Appeal of Risk Determination Hearing (Form RDH-5)_2024 05 03.pdf Form and Instruction
RDH-5 Request for Appeal of Risk Determination Hearing Request for Appeal of Risk Determination Hearing (Form RDH-5)_2024 05 03.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request for Appeal of Risk Determination Hearing (Form RDH-5)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

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	RDH-5	Request for Appeal of Risk Determination Hearing	Request for Appeal of Risk Determination Hearing (Form RDH-5)_2024 05 03.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title: ORR Division of Children's Services Records	FR Citation: 81 FR 46682

Number of Respondents: 3	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3	3
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	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.