Family Violence Prevention and Services Program

Generic Disaster Information Collection Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0476 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Family Violence Prevention and Services Program Form and Instruction
1 FVPSP DICP FVPSP DICP for OMB 21 MAR 2016.docx Form and Instruction
FVPSP Disaster Information Collection Form 21 MAR 2016.doc FVPSP IC Document

Information Collection (IC) Details

IC Title:	Family Violence Prevention and Services Program	Agency IC Tracking Number:

IC Status: New

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
Form and Instruction	1	FVPSP DICP	FVPSP DICP for OMB 21 MAR 2016.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: 10	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 Agency Discretion
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
FVPSP	FVPSP Disaster Information Collection Form 21 MAR 2016.doc	03/21/2016

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