Information Collection

Acf-196r

IC 210064 under ICR 202103-0970-009 · OMB 0970-0446.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0446 can be found here:

Documents and Forms

Document Name Document Type
ACF_196R_Instructions_Expedited Approval 3-19-21 Clean Version.docx Instruction
196R ACF-196R Form acf_196r_form - TANF ARPA - Expedited Approval.xlsx Form
Form ACF-196R Instructions Draft July 2017.doc Instructions IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	ACF-196R	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 265

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	196R	ACF-196R Form	acf_196r_form - TANF ARPA - Expedited Approval.xlsx		Yes	Yes	Fillable Fileable
Instruction			ACF_196R_Instructions_Expedited Approval 3-19-21 Clean Version.docx		Yes	No	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 51	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	204	204
Annual IC Time Burden (Hours)	2,856	2,856
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Instructions	Form ACF-196R Instructions Draft July 2017.doc	10/17/2017

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