Information Collection

Combating Autism Act Initiative Evaluation - Improving State Systems of Care Program

IC 193393 under ICR 201006-0915-004 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 001_CAAI_State Sys Combating Autism Act Initiative Evaluation - Improving State Systems of Care Program	Form and Instruction
001_CAAI_State Sys 001_CAAI_State Systems Attachment H State Systems of Care SSI protocol 42210.docx	Form and Instruction
002_CAAI_state_sys 002_CAAI_state_systems Attachment I - CAAI State Systems of Care Questionnaire.pdf	Form and Instruction

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	001_CAAI_State Systems	001_CAAI_State Systems	Attachment H State Systems of Care SSI protocol 42210.docx		Yes	Yes	Fillable Fileable
Form and Instruction	002_CAAI_state_systems	002_CAAI_state_systems	Attachment I - CAAI State Systems of Care Questionnaire.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 9

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
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	54	54
Annual IC Time Burden (Hours)	41	41
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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