Information Collection

Alzheimer's Disease Supportive Services Program (ADSSP) Data Collection

IC 178976 under ICR 201309-0985-001 · OMB 0985-0022.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0985-0022 can be found here:

Documents and Forms

Document Name Document Type
1 of 3 ADSSP Data Collection Reporting Form.xls Other-fillable spreadsheet
3 of 3 ADSSP Template for Data Collection.doc Other-fillable template
2 of 3 ADSSP Definitions for Data Collection.doc ADSSP Definitions IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Alzheimer's Disease Supportive Services Program (ADSSP) Data Collection	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-fillable spreadsheet			1 of 3 ADSSP Data Collection Reporting Form.xls		Yes	Yes	Fillable Fileable
Other-fillable template			3 of 3 ADSSP Template for Data Collection.doc		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 47	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	94	94
Annual IC Time Burden (Hours)	1,410	1,410
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
ADSSP Definitions	2 of 3 ADSSP Definitions for Data Collection.doc	05/20/2010

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