Information Collection

Annex I: Transmittal form under Article 12(2)

IC 223996 under ICR 201610-0970-010 · OMB 0970-0488.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0488 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Annex I: Transmittal form under Article 12(2) Form and Instruction
1 Annex 1 Transimittal Annex_1_Transmittal.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Annex I: Transmittal form under Article 12(2)	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	Annex 1 Transimittal	Annex_1_Transmittal.pdf		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: 54	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,484	2,484
Annual IC Time Burden (Hours)	2,484	2,484
Annual IC Cost Burden (Dollars)	0	0

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