Information Collection

Annex C: Application for Establishment of a Decision, including restriced information on the Applicant

IC 224046 under ICR 201612-0970-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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 C: Application for Establishment of a Decision, including restriced information on the Applicant Form and Instruction
1 Application for Establishment of a Decision C1_App_for_Establishment_of_a_Decision.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Annex C: Application for Establishment of a Decision, including restriced information on the Applicant	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	Application for Establishment of a Decision	C1_App_for_Establishment_of_a_Decision.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: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Previously Approved
Annual Number of Responses for this IC	270	270
Annual IC Time Burden (Hours)	135	135
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.