Information Collection

Income and Eligibility Verification

IC 13065 under ICR 199711-1205-002 · OMB 1205-0238.

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Documents and Forms

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Information Collection (IC) Details

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IC Title:	Income and Eligibility Verification	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

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

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 53	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	212	212
Annual IC Time Burden (Hours)	52,183	52,183
Annual IC Cost Burden (Dollars)	1,043,660,000	1,043,660,000

Documents for IC

Title	Document	Date Uploaded

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