Information Collection

Ryan White state officials

IC 202695 under ICR 201206-0990-003 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-RW Study Appendix E - Provider Interview Guide_03-16-2012.docx	Other-form
0990-RW Study Appendix F - Grantee Guide_May 22.docx 0990-RW Study Appendix F - Grantee Guide_May 22	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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-form			0990-RW Study Appendix E - Provider Interview Guide_03-16-2012.docx		No	No	Printable Only

Line of Business: Health

Subfunction: Illness Prevention

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
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	51	51
Annual IC Time Burden (Hours)	55	55
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0990-RW Study Appendix F - Grantee Guide_May 22	0990-RW Study Appendix F - Grantee Guide_May 22.docx	06/01/2012

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