Information Collection

FASD P-CAP Biannual

IC 191216 under ICR 200911-0930-001 · OMB 0930-0309.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Biannual Form FASD P-CAP Biannual	Form and Instruction
Biannual Form Biannual Form 7 Biannual Form.pdf	Form and Instruction
Attachment II and III.zip Attachment II and III	IC Document

IC Title:

FASD P-CAP Biannual

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	Biannual Form	Biannual Form	7 Biannual Form.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 161

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	322	322
Annual IC Time Burden (Hours)	106	106
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.