Information Collection

Access and Visitation Survey - States and Jurisdictions

IC 10033 under ICR 202104-0970-013 · OMB 0970-0204.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0204 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Access and Visitation Survey - States and Jurisdictions Form
Attachment B - Access and Visitation Instruction Manual.docx Instruction
Attachment B - Access and Visitation Instruction Manual.docx Instruction
1 AV Survey Attachment A - Grantee or Subgrantee Collection Instrument 1.xlsx Form
1 AV Survey Attachment A - Grantee or Subgrantee Collection Instrument 1.xlsx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Access and Visitation Survey - States and Jurisdictions	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 303

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	AV Survey	Attachment A - Grantee or Subgrantee Collection Instrument 1.xlsx		Yes	Yes	Fillable Printable
Instruction			Attachment B - Access and Visitation Instruction Manual.docx		Yes	Yes	Printable Only

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: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	54	54
Annual IC Time Burden (Hours)	864	864
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.