Information Collection

AIDS Drug Assistance Program Quarterly Report

IC 6549 under ICR 201402-0915-006 · OMB 0915-0294.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 AIDS Drug Assistance Program Quarterly Report	Form
1 ADAP Quarterly Report B - AQR Form.doc	Form
C - AQR Instructions 2014.docx C - AQR Instructions 2014	IC Document
D - AQR Screenshots 2014.docx D - AQR Screenshots 2014	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	ADAP Quarterly Report	B - AQR Form.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 57

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	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	57	-171	0	228
Annual IC Time Burden (Hours)	969	0	541	428
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
C - AQR Instructions 2014	C - AQR Instructions 2014.docx	02/20/2014
D - AQR Screenshots 2014	D - AQR Screenshots 2014.docx	03/26/2014

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