Information Collection

ACF-403 Record Review Worksheet: case record reviews (IC-2 - ACF-403)

IC 273857 under ICR 202501-0970-010 · OMB 0970-0323.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ACF-403 ACF-403 Record Review Worksheet: case record reviews (IC-2 - ACF-403)	Form and Instruction
Form ACF-403 Improper Payment DCI - ACF-403 Record Review Worksheet: case record reviews ACF-403 Record Review Worksheet: case record reviews (IC-2 - ACF-403)	Form and Instruction
ACF-403 Improper Payment DCI - ACF-403 Record Review Worksheet: IC-2 [ACF-403].pdf	Form and Instruction
ACF-403 Improper Payment DCI - ACF-403 Record Review Worksheet: IC-2 [ACF-403].pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 98

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
Form and Instruction	ACF-403				Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 52

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	4,784	4,784
Annual IC Time Burden (Hours)	14,352	14,352
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.

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