Form 1 RSS and RSS Set Aside Sub-grantee List

					OMB#:
					Expiration Date:
Refugee Support Services (RSS) and RSS Set Aside Sub-Grantee List
1. State/Grantee:		2. Fiscal Year:		3. Date:
4: Sub-Grantee Information
A. City	B. Name of Sub-Grantee	C. Agency Phone Number		D. Program	E. Funding Amount
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: Through this information collection, ACF is gathering information to improve communication with and keep abreast of activities at all refugee service providers receiving ORR funds. Public reporting burden for this collection of information is estimated to average 2 hours per grantee, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information.This is a mandatory collection of information 45CFR§400.28(b). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is ---- and the expiration date is ----. If you have any comments on this collection of information, please contact draprograms@acf.hhs.gov.