Information Collection

CSAP Client-Level Data

IC 213380 under ICR 201501-0930-004 · OMB 0930-0346.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CSAP Youth CSAP Client-Level Data	Form and Instruction
CSAP Youth CSAP Youth Attachment 4 Final CSAP Youth 1.12.15.docx	Form and Instruction
CSAP Adult CSAP Adult Attachment 5 Final CSAP Adult 1.12.15.doc	Form and Instruction
Attachment 9 CDP_Reference_Guide_CSAP 11 19.docx Reference_Guide_CSAP	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	CSAP Youth	CSAP Youth	Attachment 4 Final CSAP Youth 1.12.15.docx		Yes	Yes	Fillable Fileable
Form and Instruction	CSAP Adult	CSAP Adult	Attachment 5 Final CSAP Adult 1.12.15.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 19,334

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	Previously Approved
Annual Number of Responses for this IC	49,108	49,108
Annual IC Time Burden (Hours)	18,661	18,661
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Reference_Guide_CSAP	Attachment 9 CDP_Reference_Guide_CSAP 11 19.docx	12/19/2014

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