Information Collection

Beneficiary Report - Beneficiaries

IC 273178 under ICR 202412-0970-007 · OMB 0970-0642.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0642 can be found here:

Documents and Forms

Document Name Document Type
Instrument 2 - Beneficiary Report.xlsx Other-Report
Instrument 2 – Beneficiary Report (CLEAN Version).docx Other-Report

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Beneficiary Report - Beneficiaries	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Other-Report			Instrument 2 â Beneficiary Report (CLEAN Version).docx		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: 64,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	42,667	42,667
Annual IC Time Burden (Hours)	3,556	3,556
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.