Information Collection

FASD P-CAP Monthly Updates

IC 191215 under ICR 200911-0930-001 · OMB 0930-0309.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Monthly Update Monthly Update FASD P-CAP Monthly Updates	Form and Instruction
Monthly Update Monthly Update 6 MonthlyUpdate.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	Monthly Update				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	2,280	2,280
Annual IC Time Burden (Hours)	1,140	1,140
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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

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

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