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

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
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 %

table that charts list of burden
	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

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.