Information Collection

Quarterly Performance Report and Annual Performance Reporting

IC 189112 under ICR 200911-2506-004 · OMB 2506-0186.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Data Elements Annual Performance Report.docx	Other-null
Data Elements Quarterly Report.docx	Other-null
-Authorizing Legislation.doc Authorizing Legislation	IC Document
HMIS Data Standards-Final (3.17.10).doc HMIS Data Standards	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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
Other-null			Data Elements Quarterly Report.docx		Yes	Yes	Fillable Fileable Signable
Other-null			Data Elements Annual Performance Report.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 540

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,700	540	2,160
Annual IC Time Burden (Hours)	261,072	147,420	113,652
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Authorizing Legislation	-Authorizing Legislation.doc	11/20/2009
HMIS Data Standards	HMIS Data Standards-Final (3.17.10).doc	03/10/2010

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