Information Collection

FASD P-CAP Exit ASI

IC 191217 under ICR 200911-0930-001 · OMB 0930-0309.

Documents and Forms

Document Name Document Type
Form ASI Exit FASD P-CAP Exit ASI Form and Instruction
ASI Exit ASI Exit 8 ASIExit.pdf Form and Instruction
Attachment II and III.zip Attachment II and III IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	FASD P-CAP Exit ASI	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	ASI Exit	ASI Exit	8 ASIExit.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 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	190	190
Annual IC Time Burden (Hours)	428	428
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.