Information Collection

Written Notice to Beneficiaries

IC 215988 under ICR 201504-1291-001 · OMB 1291-0006.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1291-0006 can be found here:

Documents and Forms

Document Name Document Type
Notice of Beneficiary Religious Liberty Protections (Final).docx Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Written Notice to Beneficiaries	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 29 CFR 2.34

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Notice of Beneficiary Religious Liberty Protections (Final).docx		Yes	No	Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	1	1
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.