Information Collection

Semi-annual progress report for the Children and Youth Exposed to Violence Program

IC 202893 under ICR 202503-1122-002 · OMB 1122-0028.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1122-0028 Semi-annual Progress Report Form for Children Exposed to Violence Program Semi-annual progress report for the Children and Youth Exposed to Violence Program	Form
1122-0028 Semi-annual Progress Report Form for Children Exposed to CEVFormGMSSample.pdf www.gms.gov	Form

IC Title:

Agency IC Tracking Number:

1122-0028

Is this a Common Form? No

IC Status: Unchanged

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	1122-0028			www.gms.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 25

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	50	50
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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