Information Collection

Minority Substance Abuse/HIV Prevention Initiative

IC 187120 under ICR 200811-0930-002 · OMB 0930-0298.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0298 can be found here:

Documents and Forms

Document Name Document Type
Form Attach 2-5 Youth & Minority Substance Abuse/HIV Prevention Initiative Form and Instruction
Attach 2-5 Youth & Attach 2-5 Youth & Adult Surveys and Guides 2-5 Surveys.zip Form and Instruction
1-HIV AIDS DACCC-DITIC Statement of Personal Commitment.doc Attach 1Personal Statement IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Minority Substance Abuse/HIV Prevention Initiative	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
Form and Instruction	Attach 2-5 Youth & Adult Surveys and Guides	Attach 2-5 Youth & Adult Surveys and Guides	2-5 Surveys.zip		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20,205	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	20,205	20,205
Annual IC Time Burden (Hours)	16,770	16,770
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attach 1Personal Statement	1-HIV AIDS DACCC-DITIC Statement of Personal Commitment.doc	10/29/2008

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