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

Documents and forms in this information collection
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

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
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 %

table that charts list of burden
	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

table that charts IC Documents
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.