Information Collection

Behavioral Note (Form A-9E)

IC 260907 under ICR 202505-0970-002 · OMB 0970-0547.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0547 can be found here:

Documents and Forms

Document Name Document Type
Form A-9E Behavioral Note (Form A-9E) Form
A-9E Behavioral Note Behavioral Note (Form A-9E).pdf Form
A-9E Behavioral Note Behavioral Note (Form A-9E).pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Behavioral Note (Form A-9E)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	A-9E	Behavioral Note	Behavioral Note (Form A-9E).pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title: ORR Division of Children's Services Records	FR Citation: 81 FR 46682

Number of Respondents: 216	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-29,592	29,592
Annual IC Time Burden (Hours)	-14,796	14,796
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.