Child Access and Visitation Grant Application Form

State Access and Visitation Grant Application

Documents and Forms

Document Name Document Type
Form 1 Child Access and Visitation Grant Application Form Form
1 AV Application AV Program Application - Application Form - with header and directions-5.16.22 clean.docx Form
1 AV Application AV Program Application - Application Form - with header and directions-5.16.22 clean.docx Form

Information Collection (IC) Details

IC Title:	Child Access and Visitation Grant Application 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	AV Application	AV Program Application - Application Form - with header and directions-5.16.22 clean.docx		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: 54	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	54	54
Annual IC Time Burden (Hours)	540	540
Annual IC Cost Burden (Dollars)	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.