Direct Service - Staff

Targeted Capacity Expansion Program for Substance Abuse Treatment and HIV/AIDS Services (TCE-HIV)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0317 can be found here:

Documents and Forms

Document Name Document Type
Form Attachment 5 - Ins Direct Service - Staff Form and Instruction
Attachment 5 - Ins Attachment 5 - Instruments Attachment 5.pdf Form and Instruction
Attachment 6 - Con Attachment 6 - Consent Form Attachment 6.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Direct Service - Staff	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	Attachment 5 - Instruments	Attachment 5 - Instruments	Attachment 5.pdf		Yes	Yes	Paper Only
Form and Instruction	Attachment 6 - Consent Form	Attachment 6 - Consent Form	Attachment 6.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 144	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	288	288
Annual IC Time Burden (Hours)	288	288
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.