Information Collection

Output Record

IC 179585 under ICR 202504-0970-014 · OMB 0970-0161.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Output Record	Form and Instruction
Form 1 Output Record Specs Output Record	Form and Instruction
1 Output Record Specs 0970-0161_Output_Record_Specifications.docx	Form and Instruction
1 Output Record Specs 0970-0161_Output_Record_Specifications.docx	Form and Instruction

IC Title:

Output Record

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1				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: 54

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	Previously Approved
Annual Number of Responses for this IC	2,808	2,808
Annual IC Time Burden (Hours)	1,292	1,292
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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