AIDS Drug Assistance Program Quarterly Report

HRSA AIDS Drug Assistance Quarterly Report

Documents and Forms

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

Information Collection (IC) Details

IC Title:	AIDS Drug Assistance Program Quarterly Report	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:

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 %

	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

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.