View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Community Relations Service Evaluation Form	Agency IC Tracking Number:	1103-0117

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	1103-0117	CRS Evaluation Form	GEN IC Form - CRS Small Group TOF Evaluation Form 1103-0117.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	120	0	120	0	0	0
Annual IC Time Burden (Hours)	10	0	10	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Template for GEN IC CRS Evaluation Form	Generic IC Template - CRS Small Group TOF Evaluation Form 1103-0117.pdf	05/18/2021

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