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Child Support Agency Confidential Information Form
45 CFR 303.7 - Provision of Services in Intergovernmental IV-D; Federally Approved Forms
OMB: 0970-0085
IC ID: 222797
OMB.report
HHS/ACF
OMB 0970-0085
ICR 202311-0970-009
IC 222797
( )
Documents and Forms
Document Name
Document Type
Form 1
Child Support Agency Confidential Information Form
Form and Instruction
1 Child Support Agency Confidential Information
Child Support Agency Confidential Information Form 2019 Final 12112019.docx
Form and Instruction
1 Child Support Agency Confidential Information
Child Support Agency Confidential Information Form 2019 Final 12112019.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Child Support Agency Confidential Information Form
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
45 CFR 303.7(a)(4)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
1
Child Support Agency Confidential Information
Child Support Agency Confidential Information Form 2019 Final 12112019.docx
Yes
Yes
Fillable Printable
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:
54
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 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
1,039,932
0
0
0
0
1,039,932
Annual IC Time Burden (Hours)
51,997
0
0
0
0
51,997
Annual IC Cost Burden (Dollars)
0
0
0
0
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.