Information Collection

Understanding and Monitoring Funding Streams in Ryan White Clinics Survey

IC 209908 under ICR 201312-0915-007 · OMB 0915-0377.

Documents and Forms

Document Name Document Type
Form 1 Understanding and Monitoring Funding Streams in Ryan White Clinics Survey Form and Instruction
1 Understanding and Monitoring Funding Streams in Ryan Whi Attachment A - Survey Instrument_Draft_2014 Final Revisions.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Understanding and Monitoring Funding Streams in Ryan White Clinics Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Understanding and Monitoring Funding Streams in Ryan White Clinics Survey	Attachment A - Survey Instrument_Draft_2014 Final Revisions.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	564	564
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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