Information Collection

Three Month E-mail

IC 212466 under ICR 201406-0970-009 · OMB 0970-0447.

Documents and Forms

Document Name Document Type
Form 1 Three Month E-mail Form and Instruction
1 Three Month Email 3 Month Follow-up Email 7.24.14.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Three Month E-mail	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Three Month Email	3 Month Follow-up Email 7.24.14.doc		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	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
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	120	120
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.