Information Collection

Client Characteristics and Program Entry

IC 239400 under ICR 202502-0970-031 · OMB 0970-0542.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0542 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 FY25 DVHT Performance Indicators Client Characteristics and Program Entry	Form
FY25 DVHT Reporting Reference Guide_CleanWithChanges.docx	Instruction
FY25 DVHT Reporting Reference Guide_CleanWithChanges.docx	Instruction
2 FY25 DVHT Performance Indicators FY25 DVHT Performance Indicators_CleanWithChanges.docx	Form
2 FY25 DVHT Performance Indicators FY25 DVHT Performance Indicators_CleanWithChanges.docx	Form
FY25 DVHT PPR Workbook_SpecifyQuarterNo._SpecifyGrantRecipientName_CleanWithChanges.xlsx DVHT PPR Workbook	IC Document
FY25 DVHT PPR Workbook_SpecifyQuarterNo._SpecifyGrantRecipientName_CleanWithChanges.xlsx DVHT PPR Workbook	IC Document

IC Title:

Client Characteristics and Program Entry

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction					Yes	Yes	Printable Only
Form	2				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: 1,700

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	567	567
Annual IC Time Burden (Hours)	425	425
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
DVHT PPR Workbook		02/25/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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