Information Collection

Ryan White CARE Act Title I Minority AIDS Initiative Report: Title I Report

IC 46219 under ICR 201307-0915-001 · OMB 0915-0304.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Ryan White CARE Act Title I Minority AIDS Initiative Report: Title I Report	Form
1 screen shots Attachment A - Screen Shots of Sample Web Form from Part A MAI Report Web Application.doc	Form
Attach B - FY 2012 Part A MAI Reporting Instructions, 3-23-2012.pdf Instructions	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	screen shots	Attachment A - Screen Shots of Sample Web Form from Part A MAI Report Web Application.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 53

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	106	-6	112
Annual IC Time Burden (Hours)	2,533	1,973	560
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Instructions	Attach B - FY 2012 Part A MAI Reporting Instructions, 3-23-2012.pdf	06/25/2013

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