Information Collection

Baseline Information Form

IC 212717 under ICR 201801-0970-005 · OMB 0970-0440.

Documents and Forms

Document Name Document Type
JSA OMB Attachment A Baseline Information Form - July 2014 - Revised.docx Other-BIF

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Baseline Information Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-BIF			JSA OMB Attachment A Baseline Information Form - July 2014 - Revised.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,750	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-3,750	3,750
Annual IC Time Burden (Hours)	-750	750
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.