Information Collection

CJRP- JRFC Pilot Test

IC 245907 under ICR 202010-1121-004 · OMB 1121-0360.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0360 can be found here:

Documents and Forms

Document Name Document Type
Form 1121-0360 CJRP- JRFC Pilot Test Form and Instruction
1121-0360 Appendix D: CJRP Questionnaire AppendixD-CJRP_Instrument_Revised.docx Form and Instruction
1121-0360 Appendix E: JRFC Questionnaire AppendixE-JFRC_Instrument_Revised.docx Form and Instruction
OMB Memo - CJRP- JRFC Pilot Test-OMB_Revised.docx OMB Memo IC Document
OMB Memo - CJRP- JRFC Pilot Test-OMB_Revised_TRACKED.docx OMB Memo Tracked Changes IC Document
GEN IC (1121-0360) - CJRP- JRFC Pilot Test.docx GEN IC Template IC Document
AppendixA-Acts.pdf Appendix A IC Document
AppendixB-Contact_Materials-OMB_Revised.docx Appendix B IC Document
AppendixC-ExternalConsultants.docx Appendix C IC Document
AppendixF-Confidentiality.pdf Appendix F IC Document
AppendixG-IRB_PrivacyCertificate.pdf Appendix G IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CJRP- JRFC Pilot Test	Agency IC Tracking Number:	1121-0360

IC Status: New

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
Form and Instruction	1121-0360	Appendix D: CJRP Questionnaire	AppendixD-CJRP_Instrument_Revised.docx		Yes	Yes	Fillable Fileable
Form and Instruction	1121-0360	Appendix E: JRFC Questionnaire	AppendixE-JFRC_Instrument_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: 360	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	360	360
Annual IC Time Burden (Hours)	1,026	1,026
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Memo	OMB Memo - CJRP- JRFC Pilot Test-OMB_Revised.docx	02/19/2021
OMB Memo Tracked Changes	OMB Memo - CJRP- JRFC Pilot Test-OMB_Revised_TRACKED.docx	02/19/2021
GEN IC Template	GEN IC (1121-0360) - CJRP- JRFC Pilot Test.docx	02/19/2021
Appendix A	AppendixA-Acts.pdf	02/19/2021
Appendix B	AppendixB-Contact_Materials-OMB_Revised.docx	02/19/2021
Appendix C	AppendixC-ExternalConsultants.docx	02/19/2021
Appendix F	AppendixF-Confidentiality.pdf	02/19/2021
Appendix G	AppendixG-IRB_PrivacyCertificate.pdf	02/19/2021

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