Information Collection

Barriers to Service Delivery and Monitoring

IC 239404 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
FY25 DVHT Reporting Reference Guide_CleanWithChanges.docx Instruction
FY25 DVHT Reporting Reference Guide_CleanWithChanges.docx Instruction
4 Barriers to Service Delivery and Monitoring Form FY25 DVHT Performance Indicators_CleanWithChanges.docx Form
4 Barriers to Service Delivery and Monitoring Form FY25 DVHT Performance Indicators_CleanWithChanges.docx Form
FY25 DVHT PPR Workbook_SpecifyQuarterNo._SpecifyGrantRecipientName_CleanWithChanges.xlsx FY25 DVHT PPR Workbook IC Document
FY25 DVHT PPR Workbook_SpecifyQuarterNo._SpecifyGrantRecipientName_CleanWithChanges.xlsx FY25 DVHT PPR Workbook IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Barriers to Service Delivery and Monitoring	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			FY25 DVHT Reporting Reference Guide_CleanWithChanges.docx		Yes	Yes	Printable Only
Form	4	Barriers to Service Delivery and Monitoring Form	FY25 DVHT Performance Indicators_CleanWithChanges.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: 35	Number of Respondents for Small Entity: 5

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	47	47
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
FY25 DVHT PPR Workbook	FY25 DVHT PPR Workbook_SpecifyQuarterNo._SpecifyGrantRecipientName_CleanWithChanges.xlsx	02/25/2025

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