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Federal forms, ICRs, and supporting documents

Information Collection

Authorization for Release of Records (Form A-5 & A-5s)

IC 241072 under ICR 202406-0970-006 · OMB 0970-0547.

Documents and Forms
Document Name
Document Type
Form
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

Authorization for Release of Records (Form A-5 & A-5s)
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form A-5 Authorization for Release of Records (English) A-5 (ENG) Authorization for Release of Records_v3_English.pdf Yes Yes Fillable Fileable
Form A-5s Authorization for Release of Records (Spanish) A-5 (ESP) Authorization for Release of Records_v3_Spanish.pdf Yes Yes Fillable Fileable

Community and Social Services Social Services

 

4,000 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,000 0 0 0 0 4,000
Annual IC Time Burden (Hours) 1,000 0 0 0 0 1,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.