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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.