Information Collection

HRSA AIDS Drug Assistance Quarterly Report

IC 6549 under ICR 201102-0915-002 · OMB 0915-0294.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0294 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 HRSA AIDS Drug Assistance Quarterly Report	Form
C - AQR Instructions_revised_3.18.11.docx	Instruction
1 ADAP Quarterly Report B - AQR Form.doc	Form

IC Title:

HRSA AIDS Drug Assistance Quarterly Report

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	ADAP Quarterly Report	B - AQR Form.doc		Yes	Yes	Fillable Fileable
Instruction			C - AQR Instructions_revised_3.18.11.docx		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 57

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	228	228
Annual IC Time Burden (Hours)	428	428
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.