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Family Violence Prevention and Services Program Disaster Information Collection Form
Generic Disaster Information Collection Forms
OMB: 0970-0476
IC ID: 276119
OMB.report
HHS/ACF
OMB 0970-0476
ICR 202507-0970-006
IC 276119
( )
Documents and Forms
Document Name
Document Type
Form 1
Family Violence Prevention and Services Program Disaster Information Collection Form
Form
1 Family Violence Prevention Service Program Disaster Info
FVPSP Disaster Info Collection Instrument_exp_07312025 (1).docx
Form
FVPSP Disaster Info Collection Submission Form.docx
GenIC - Family Violence Prevention Service Program Disaster Information Collection Form
IC Document
NOA_DICP_0970-0476_7.15.22.pdf
NOA - Family Violence Prevention Service Program Disaster Information Collection Form
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Family Violence Prevention and Services Program Disaster Information Collection Form
Agency IC Tracking Number:
OFVPS
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
1
Family Violence Prevention Service Program Disaster Information Collection Form
FVPSP Disaster Info Collection Instrument_exp_07312025 (1).docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
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:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
85 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
10
0
10
0
0
0
Annual IC Time Burden (Hours)
10
0
10
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
GenIC - Family Violence Prevention Service Program Disaster Information Collection Form
FVPSP Disaster Info Collection Submission Form.docx
07/02/2025
NOA - Family Violence Prevention Service Program Disaster Information Collection Form
NOA_DICP_0970-0476_7.15.22.pdf
07/03/2025
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.