Household Services and Outcomes Submission Report 52698(a)

Eviction Protection Grant Program

Documents and Forms

Document Name Document Type
Household Services and Outcomes Submission Report_52698a.xlsx Other-Submission Report

Information Collection (IC) Details

IC Title:	Household Services and Outcomes Submission Report 52698(a)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Other-Submission Report			Household Services and Outcomes Submission Report_52698a.xlsx		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: 21	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	84	84
Annual IC Time Burden (Hours)	84	84
Annual IC Cost Burden (Dollars)	5,152	5,152

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.