Information Collection

Withold Response

IC 209102 under ICR 201310-0970-003 · OMB 0970-0441.

Documents and Forms

Document Name Document Type
Form 1 Withold Response Form and Instruction
1 Fast Levy Record Layout FAST Levy Record Layout v1.0_092513.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Withold Response	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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	Fast Levy Record Layout	FAST Levy Record Layout v1.0_092513.docx		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: 5	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	5	5
Annual IC Time Burden (Hours)	1,588	1,588
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.