Information Collection

ACF-403 Record Review Worksheet: template (IC-2 - ACF-403)

IC 181816 under ICR 202501-0970-010 · OMB 0970-0323.

Documents and Forms

Document Name Document Type
Form ACF-403 ACF-403 Record Review Worksheet: template (IC-2 - ACF-403) Form and Instruction
ACF-403 Improper Payment DCI - ACF-403 Record Review Worksheet: IC-2 [ACF-403].pdf Form and Instruction
ACF-403 Improper Payment DCI - ACF-403 Record Review Worksheet: IC-2 [ACF-403].pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	ACF-403 Record Review Worksheet: template (IC-2 - ACF-403)	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 98

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ACF-403	Improper Payment DCI - ACF-403 Record Review Worksheet: template	IC-2 [ACF-403].pdf		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 52	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	17	-4,767	4,784
Annual IC Time Burden (Hours)	1,092	-29,191	30,283
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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