Application for Pacific Islands Supplemental Funding

Communities Putting Prevention to Work

Documents and Forms

Document Name Document Type
Form 4 Application for Pacific Islands Supplemental Funding Form and Instruction
4 Application for Pacific Islands Supplemental Funding 0920-0820 Supplemental Funding Application for PI 9.16.2009.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Application for Pacific Islands Supplemental Funding	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	4	Application for Pacific Islands Supplemental Funding	0920-0820 Supplemental Funding Application for PI 9.16.2009.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6	6
Annual IC Time Burden (Hours)	180	180
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.