FASD P-CAP Client Lost Post Exit

Fetal Alcohol Spectrum Disorder (FASD) Center for Excellence Parent-Child Assistance Program (P-CAP)

Documents and Forms

Document Name Document Type
Form Client Lost Post E FASD P-CAP Client Lost Post Exit Form and Instruction
Client Lost Post E Client Lost Post Exit 11 Client Lost Post Exit.pdf Form and Instruction
Attachment II and III.zip Attachment II and III IC Document

Information Collection (IC) Details

IC Title:	FASD P-CAP Client Lost Post Exit	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	Client Lost Post Exit	Client Lost Post Exit	11 Client Lost Post Exit.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 29	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	29	29
Annual IC Time Burden (Hours)	7	7
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.