Information Collection

Client Data Reporting System - Outpatient And Partial Care Services

IC 111853 under ICR 198007-0930-001 · OMB 0930-0046.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0046 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	CLIENT DATA REPORTING SYSTEM - OUTPATIENT AND PARTIAL CARE SERVICES	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	ADM 569-1	No	No
Form	ADM 569-2	No	No
Form	ADM 569-3A	No	No
Form	ADM 569-3B	No	No
Form	ADM 569-4	No	No
Form	ADM 569-5	No	No
Form	ADM 569-6A	No	No
Form	ADM 569-6B	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	3,184	3,184
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

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