Information Collection

State of the States in Services and Supports for ASD: Data Collection and Verification Tool

IC 198119 under ICR 201107-0938-011 · OMB 0938-1142.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Data Collection Tool [rev 06-13-11].doc	Other-Data Collection Tool
IACC_2010_Strategic_Plan_Attachment B11-10.pdf 2010 IACC Strategic Plan	IC Document
2011 IACC Strategic Plan for ASD Research.pdf 2011 IACC Strategic Plan	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
Other-Data Collection Tool			Data Collection Tool [rev 06-13-11].doc		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 51

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	153	153
Annual IC Time Burden (Hours)	268	268
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2010 IACC Strategic Plan	IACC_2010_Strategic_Plan_Attachment B11-10.pdf	07/21/2011
2011 IACC Strategic Plan	2011 IACC Strategic Plan for ASD Research.pdf	07/21/2011

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