Alzheimer's Disease Supportive Services Program (ADSSP) Data Collection

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0985-0022 can be found here:

Documents and Forms

Document Name Document Type
ADSSP Data Collection Reporting Form (2).xls Other-fillable spreadsheet
ADSSP Template for Data Collection (2).doc Other-fillable template
2 of 3 ADSSP Definitions for Data Collection.doc ADSSP Definitions IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Alzheimer's Disease Supportive Services Program (ADSSP) Data Collection	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-fillable template			ADSSP Template for Data Collection (2).doc		Yes	Yes	Fillable Fileable
Other-fillable spreadsheet			ADSSP Data Collection Reporting Form (2).xls		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 47	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	Previously Approved
Annual Number of Responses for this IC	94	56	38
Annual IC Time Burden (Hours)	1,410	460	950
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
ADSSP Definitions	2 of 3 ADSSP Definitions for Data Collection.doc	05/20/2010

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