Information Collection

Income and Eligibility Verification

IC 13067 under ICR 200102-1205-001 · 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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	212	0	212
Annual IC Time Burden (Hours)	39,388	-12,795	52,183
Annual IC Cost Burden (Dollars)	985,000	-1,042,675,000	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.