Service Providers

Cross-Community Evaluation of the Native Aspirations Project

Documents and Forms

Document Name Document Type
Form Service_Provider_I Service Providers Form and Instruction
Service_Provider_I Service_Provider_Instruments Attachment 7-Service_Provider_Instruments.pdf Form and Instruction
Attachment 8-Service_Provider_Supporting.pdf Service_Provider_Supporting IC Document

Information Collection (IC) Details

IC Title:	Service Providers	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	Service_Provider_Instruments	Service_Provider_Instruments	Attachment 7-Service_Provider_Instruments.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 378	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	378	378
Annual IC Time Burden (Hours)	756	756
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Service_Provider_Supporting	Attachment 8-Service_Provider_Supporting.pdf	06/10/2010

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