Information Collection

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

IC 249480 under ICR 202406-0970-006 · OMB 0970-0547.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0547 can be found here:

Documents and Forms

Document Name Document Type
Form A-5 Authorization for Release of Records (Form A-5 & A-5s) - Record keeping Form
A-5 Authorization for Release of Records A-5 Authorization for Release of Records 04.08.22.pdf Form
A-5s Authorization for Release of Records - Spanish A-5s Authorization for Release of Records - final 05.03.22.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Authorization for Release of Records (Form A-5 & A-5s) - Record keeping	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	A-5	Authorization for Release of Records	A-5 Authorization for Release of Records 04.08.22.pdf		Yes	Yes	Fillable Fileable
Form	A-5s	Authorization for Release of Records - Spanish	A-5s Authorization for Release of Records - final 05.03.22.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: 216	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	4,104	4,104
Annual IC Time Burden (Hours)	1,368	1,368
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.