Information Collection

Adoptive Family Relief Act Refund Application

IC 221041 under ICR 201610-1405-003 · OMB 1405-0223.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0223 can be found here:

Documents and Forms

Document Name Document Type
Form DS-7781 Adoptive Family Relief Act Refund Application Form
DS-7781 Adoptive Family Relief Act Refund Application DS-7781.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Adoptive Family Relief Act Refund Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	DS-7781	Adoptive Family Relief Act Refund Application	DS-7781.pdf		Yes	No	Fillable Printable

Line of Business: International Affairs and Commerce

Subfunction: Foreign Affairs

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	50	50
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.