Information Collection

Ryan White HIV/AIDS Program Data Report Form

IC 6504 under ICR 201012-0915-003 · OMB 0915-0253.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Ryan White HIV/AIDS Program Data Report Form	Form
1 Ryan White HIV/AIDS Program Data Report 2010_RDR_Form.doc	Form
2010_RDR_Instructions.doc Instructions for Completing the Ryan White Data Report	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
Form	1	Ryan White HIV/AIDS Program Data Report	2010_RDR_Form.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,647

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,647	-250	2,897
Annual IC Time Burden (Hours)	86,766	-7,476	94,242
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Instructions for Completing the Ryan White Data Report	2010_RDR_Instructions.doc	12/02/2010

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