Information Collection

State Department of Education Contacts Form

IC 237567 under ICR 202009-0970-010 · OMB 0970-0531.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0531 can be found here:

Documents and Forms

Document Name Document Type
State Contacts Form-10-7-19 - clean.docx Other-
Supporting Statement-State Department of Education Contacts Form-10-7-19 - clean.doc Supporting Statement A - State Department of Education Contacts Form IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State Department of Education Contacts Form	Agency IC Tracking Number:

IC Status: Unchanged

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
Other-			State Contacts Form-10-7-19 - clean.docx		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: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	54	54
Annual IC Time Burden (Hours)	54	54
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A - State Department of Education Contacts Form	Supporting Statement-State Department of Education Contacts Form-10-7-19 - clean.doc	10/08/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.