Information Collection

Data Entry Form

IC 178917 under ICR 200703-0970-001 · OMB 0970-0319.

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Information Collection (IC) Details

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IC Title:	Data Entry Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 17	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,698	4,698
Annual IC Time Burden (Hours)	652	652
Annual IC Cost Burden (Dollars)	24,383	24,383

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