Client Characteristics and Enrollment Form

Domestic Victims of Human Trafficking Program Data

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0542 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Client Characteristics and Enrollment Form Form
1 Client Characteristics and Enrollment Form 0970-0542 - DVHT Client Characteristics and Enrollment Form_Updated.pdf Form
1 Client Characteristics and Enrollment Form 0970-0542 - DVHT Client Characteristics and Enrollment Form_Clean.pdf Form
DVHT Grantee Reporting Reference Guide_1.21.20.docx DVHT Grantee Reporting Reference Guide IC Document
FY21 DVHT Grantee Reporting Reference Guide_Clean.docx DVHT Grantee Reporting Reference Guide IC Document

Information Collection (IC) Details

IC Title:	Client Characteristics and Enrollment Form	Agency IC Tracking Number:

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	1	Client Characteristics and Enrollment Form	0970-0542 - DVHT Client Characteristics and Enrollment Form_Clean.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: 1,908	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	636	636
Annual IC Time Burden (Hours)	636	636
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
DVHT Grantee Reporting Reference Guide	FY21 DVHT Grantee Reporting Reference Guide_Clean.docx	09/21/2021

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