Information Collection

Request for Certification of Foreign National Adult Victims of Human Trafficking

IC 215217 under ICR 202504-0970-008 · OMB 0970-0454.

Documents and Forms

Document Name Document Type
Form 1 Request for Certification of Foreign National Adult Victims of Human Trafficking Form
Form 1 Request for Certification of Foreign National Adult Victims of Human Trafficking Request for Certification of Foreign National Adult Victims of Human Trafficking Form
Shepherd RFC Webform Instructions.pdf Instruction
Shepherd RFC Webform Instructions.pdf Instruction
1 Request for Certification of Foreign National Adult Vict HHS RFC 0970-0454.pdf Form
1 Request for Certification of Foreign National Adult Vict HHS RFC 0970-0454.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request for Certification of Foreign National Adult Victims of Human Trafficking	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
Form	1	Request for Certification of Foreign National Adult Victims of Human Trafficking	HHS RFC 0970-0454.pdf		Yes	Yes	Fillable Printable
Instruction			Shepherd RFC Webform Instructions.pdf		Yes	Yes	Printable Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,872	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	623	190	433
Annual IC Time Burden (Hours)	624	191	433
Annual IC Cost Burden (Dollars)	0	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.

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