Information Collection

Partnerships with Faith-Based and Other Neighborhood Organizations

IC 217481 under ICR 201507-1121-002 · OMB 1121-0353.

Documents and Forms

Document Name Document Type
Form XXXX Partnerships with Faith-Based and Other Neighborhood Organizations Form and Instruction
XXXX Beneficiary Referral Request 1121-NEW NPRM_Beneficiary Request form_071515.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Partnerships with Faith-Based and Other Neighborhood Organizations	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 28 CFR Part 38 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	XXXX	Beneficiary Referral Request	1121-NEW NPRM_Beneficiary Request form_071515.doc		Yes	Yes	Printable Only

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	150	150
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.