Form for Grantees Funding Attorney General Office

The Pregnancy Assistance Fund (PAF) Performance, FY2017-FY2019, revised for cohort 5

Documents and Forms

Document Name Document Type
0990-0460 Form for State Attorney General_PAF PM 2018_rev12212018_OMB_OAH response4112019CLEAN.docx Other-survey

Information Collection (IC) Details

IC Title:	Form for Grantees Funding Attorney General Office	Agency IC Tracking Number:

Is this a Common Form? No		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
Other-survey			0990-0460 Form for State Attorney General_PAF PM 2018_rev12212018_OMB_OAH response4112019CLEAN.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2	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	2	2
Annual IC Time Burden (Hours)	4	4
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.