Information Collection

SIRS Individual Interaction-Complex Form

IC 243845 under ICR 202009-0985-002 · OMB 0985-0040.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0985-0040 can be found here:

Documents and Forms

Document Name Document Type
Form 12 SIRS Individual Interaction-Complex Form Form and Instruction
12 SIRS Individual Interaction-Complex Form 0040 (12) SIRS Individual Interaction Complex Interaction Form Fin 20.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SIRS Individual Interaction-Complex Form	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	12	SIRS Individual Interaction-Complex Form	0040 (12) SIRS Individual Interaction Complex Interaction Form Fin 20.pdf		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: 6,935	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	13,870	13,870
Annual IC Time Burden (Hours)	1,156	1,156
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.