ACF Optional-Use Data Sharing Request Form

Formative Data Collections for ACF Program Support

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0531 can be found here:

Documents and Forms

Document Name Document Type
ACF Optional-Use Data Sharing Request Form - PRA Review - Updated.docx Other-
ACF Optional-Use Data Sharing Request Form - PRA Review - Updated.docx Other-
SSA - Formative for ACF Program Support - GenIC - Data Sharing Request Template_fnl clean.docx SSA - ACF Optional-Use Data Sharing Request Form IC Document
SSA - Formative for ACF Program Support - GenIC - Data Sharing Request Template_fnl clean.docx SSA - ACF Optional-Use Data Sharing Request Form IC Document

Information Collection (IC) Details

IC Title:	ACF Optional-Use Data Sharing Request Form	Agency IC Tracking Number:	OPRE

IC Status: Unchanged

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
Other-			ACF Optional-Use Data Sharing Request Form - PRA Review - Updated.docx		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: 100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	300	300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA - ACF Optional-Use Data Sharing Request Form	SSA - Formative for ACF Program Support - GenIC - Data Sharing Request Template_fnl clean.docx	05/15/2023

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