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

Document Name Document Type
Form 1122-0028 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

Information Collection (IC) Details

View Information Collection (IC)

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

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1122-0028	Semi-annual Progress Report Form for Children Exposed to Violence Program	CEVFormGMSSample.pdf	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 %

	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

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.