Information Collection

Intended Use Plan

IC 246254 under ICR 202402-0970-004 · OMB 0970-0234.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0234 can be found here:

Documents and Forms

Document Name Document Type
SSBG_ Intended Use Plan_IUP Instructions.pdf Instruction
SSBG_ Intended Use Plan_IUP Instructions.pdf Instruction
1 Intended Use Plan SSBG_Intended Use Plan.pdf Form
1 Intended Use Plan SSBG_Intended Use Plan.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Intended Use Plan	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 1397c (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			SSBG_ Intended Use Plan_IUP Instructions.pdf		Yes	Yes	Printable Only
Form	1	Intended Use Plan	SSBG_Intended Use Plan.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: 57	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	Previously Approved
Annual Number of Responses for this IC	57	1	56
Annual IC Time Burden (Hours)	2,280	40	2,240
Annual IC Cost Burden (Dollars)	0	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.