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pdfOMB Control Number: 0970-0467
Expiration Date: 11/30/2018
Trafficking Victim Assistance Program Grantee
Partnership Development and Expansion: Exit Form
Complete this form every time a partner is disenrolled form the grantee's network.
Grantee:
Reporting Period Start Date
Reporting Period End Date
Report Type
Name of Partner Organization/Agency
City
State or Territory
Disenrollment Date
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)
Public reporting burden for this collection of information is estimated to average .083 hours per response, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a currently valid OMB control number.
File Type | application/pdf |
File Modified | 2019-10-01 |
File Created | 2019-10-01 |