Care Demonstration Project End of Year Care Template (EOYC)

Adolescent Family Life Care Demonstration Project End of Year Care Template (EOYC)

OMB: 0990-0299

IC ID: 10433

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Care Demonstration Project End of Year Care Template (EOYC)
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction eoy_instructions_care _and_prevention_doc_final.doc Yes Yes Paper Only
Other-survey EOY care template_final_8-13-09.doc Yes Yes Fillable Printable

Health Public Health Monitoring

 

31 0
   
Private Sector Businesses or other for-profits
 
   25 %

  Approved 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 31 0 -19 0 0 50
Annual IC Time Burden (Hours) 2,015 0 1,909 0 0 106
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy