Information Collection

ADAP Grantee Report

IC 199933 under ICR 201110-0915-004 · OMB 0915-0345.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0345 can be found here:

Documents and Forms

Document Name Document Type
Form 1 ADAP Grantee Report Form
1 ADAP Grantee Report C - ADR Grantee Report.doc Form
B - ADR Web Application Screen Shots.doc ADAP Grantee Report Screenshots IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	ADAP Grantee Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	ADAP Grantee Report	C - ADR Grantee Report.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 57	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	114	114
Annual IC Time Burden (Hours)	1,425	1,425
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
ADAP Grantee Report Screenshots	B - ADR Web Application Screen Shots.doc	10/12/2011

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