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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.