Form CB-496, "Title IV-E Program Quarterly Financial Report

IV-E Foster Care and Adoption Assistance Quarterly Financial Report

Documents and Forms

Document Name Document Type
Form CB-496 Form CB-496, "Title IV-E Program Quarterly Financial Report Form
Instructions CB-496 DRAFT July 2015.docx Instruction
CB-496 Quarterly Financial Report CB-496 DRAFT Parts 1-2-3-4 July 2015.pdf Form

Information Collection (IC) Details

IC Title:	Form CB-496, "Title IV-E Program Quarterly Financial Report	Agency IC Tracking Number:	OA

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	CB-496	Quarterly Financial Report	CB-496 DRAFT Parts 1-2-3-4 July 2015.pdf		Yes	Yes	Fillable Printable
Instruction			Instructions CB-496 DRAFT July 2015.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: 67	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	268	20	248
Annual IC Time Burden (Hours)	5,628	668	4,960
Annual IC Cost Burden (Dollars)	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.