Information Collection

Supplemental Work Outcomes Report

IC 272339 under ICR 202411-0970-006 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
3A. Instructions - Supplemental Work Outcomes Report2.docx	Instruction
3A. Instructions - Supplemental Work Outcomes Report2.docx	Instruction
3 Supplemental Work Outcomes Report 3B. Supplemental Work Outcomes Report.xlsx	Form
3 Supplemental Work Outcomes Report 3B. Supplemental Work Outcomes Report.xlsx	Form

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
Instruction			3A. Instructions - Supplemental Work Outcomes Report2.docx		Yes	Yes	Printable Only
Form	3	Supplemental Work Outcomes Report	3B. Supplemental Work Outcomes Report.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title: Temporary Assistance for Needy Families (TANF) Data

FR Citation: 89 FR 25880

Number of Respondents: 54

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	54	54
Annual IC Time Burden (Hours)	1,620	1,620
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.