Information Collection

FASD P-CAP Weekly Time Summary

IC 191214 under ICR 200911-0930-001 · OMB 0930-0309.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Weekly Time Summar FASD P-CAP Weekly Time Summary	Form and Instruction
Weekly Time Summar Weekly Time Summary 5 - Advocate Time Summary.pdf	Form and Instruction
Attachment II and III.zip Attachment II and III	IC Document

IC Title:

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	Weekly Time Summary	Weekly Time Summary	5 - Advocate Time Summary.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 190

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	9,880	9,880
Annual IC Time Burden (Hours)	4,940	4,940
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment II and III	Attachment II and III.zip	10/27/2009

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