Information Collection

Monitoring

IC 220839 under ICR 202502-1121-001 · OMB 1121-0243.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Monitoring	Form
Monitoring Monitoring	Form
Monitoring CMT screen shots (3).pdf	Form
Monitoring CMT screen shots (3).pdf	Form
Justification for change on OVC Victim Compensation State Certification form 1121.docx Justification	IC Document
Justification for change on OVC Victim Compensation State Certification form 1121.docx Justification	IC Document

IC Title:

Monitoring

Agency IC Tracking Number:

OAAM

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
Form	none			n/a	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,893

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	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,893	1,840	53
Annual IC Time Burden (Hours)	1,893	1,840	53
Annual IC Cost Burden (Dollars)	169,234	164,496	4,738

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification		03/23/2017

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

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