Semi-annual Progress Report for Safe Havens: Supervised Visitation and Safe Exchange Grant Program

Documents and Forms

Document Name Document Type
Form 1122-0009 Semi-annual Progress Report for Safe Havens: Supervised Visitation and Safe Exchange Grant Program Form
1122-0009 Semi Annual Progress Report for Supervised Visitation Pr SafeHavensFormGMSSample2014.docx www.gms.gov Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Semi-annual Progress Report for Safe Havens: Supervised Visitation and Safe Exchange Grant Program	Agency IC Tracking Number:	1122-0009

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1122-0009	Semi Annual Progress Report for Supervised Visitation Program	SafeHavensFormGMSSample2014.docx	www.gms.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6	Number of Respondents for Small Entity: 6

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	12	-54	66
Annual IC Time Burden (Hours)	12	-54	66
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.