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Insurance Match Debt Inquiry Agreement and Profile
Child Support Portal Registration
OMB: 0970-0370
IC ID: 233424
OMB.report
HHS/ACF
OMB 0970-0370
ICR 202411-0970-010
IC 233424
( )
Documents and Forms
Document Name
Document Type
Form 1
Insurance Match Debt Inquiry Agreement and Profile
Form and Instruction
1 Insurance Match Debt Inquiry Agreement and Profile
0970-0370_Insurance_Match_Debt_Inquiry_Agmt_Profile.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Insurance Match Debt Inquiry Agreement and Profile
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
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
1
Insurance Match Debt Inquiry Agreement and Profile
0970-0370_Insurance_Match_Debt_Inquiry_Agmt_Profile.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Social Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
6
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Requested
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
6
0
-12
0
0
18
Annual IC Time Burden (Hours)
0
0
-1
0
0
1
Annual IC Cost Burden (Dollars)
0
0
0
0
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.