Information Collection

ADAP Grantee Report

IC 199933 under ICR 201408-0915-002 · OMB 0915-0345.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0345 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 ADAP Grantee Report	Form and Instruction
Instruction Manual.docx	Instruction
2 ADR Grantee Report Grantee Report.docx	Form and Instruction

IC Title:

ADAP Grantee 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:

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	2	ADR Grantee Report	Grantee Report.docx		Yes	Yes	Fillable Fileable
Instruction			Instruction Manual.docx		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 54

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	Previously Approved
Annual Number of Responses for this IC	54	-60	114
Annual IC Time Burden (Hours)	4,374	2,949	1,425
Annual IC Cost Burden (Dollars)	0	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.