Information Collection

Client Eligibility Documentation Form

IC 254744 under ICR 202411-2528-002 · OMB 2528-0335.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix B. Client Eligibility Documentation Form_OAHM_Final.docx	Other-Client Eligibility Documentati
Appendix B. Client Eligibility Documentation Form_OAHM_Final.docx	Other-Client Eligibility Documentati
Appendix B. Client Eligibility _EOAHMP-C2.DRAFT (clean).docx	Other-Appendix B. Client Eligibility
Appendix B. Client Eligibility _EOAHMP-C2.DRAFT (clean).docx	Other-Appendix B. Client Eligibility

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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
Other-Client Eligibility Documentation Form			Appendix B. Client Eligibility Documentation Form_OAHM_Final.docx		No		Paper Only
Other-Appendix B. Client Eligibility _EOAHMP-C2.DRAFT (clean)			Appendix B. Client Eligibility _EOAHMP-C2.DRAFT (clean).docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,478

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	4,478	4,478
Annual IC Time Burden (Hours)	358	358
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.