Information Collection

Semi-Annual Performance Report for the Financial Assistance to Victims of Domestic Violence, Dating Violence, Sexual Assault, and Stalking Program

IC 279175 under ICR 202602-1122-005 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form New Semi-Annual Performance Report for the Financial Assistance to Victims of Domestic Violence, Dating Violence, Sexual Assault, and Stalking Program Semi-Annual Performance Report for the Financial Assistance to Victims of Domestic Violence, Dating Violence, Sexual Assault, and Stalking Program	Form
New Semi-Annual Performance Report for the Financial Assista FAV Program.pdf www.vawamei.org/tools-resource/financial-assistance-for-victims-performance-report/	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	New			https://www.vawamei.org/tools-resource/financial-assistance-for-victims-performance-report/	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: 16

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	32	32
Annual IC Time Burden (Hours)	32	32
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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