FTDC Form

Family Treatment Drug Court Services (FTDC) Evaluation

Documents and Forms

Document Name Document Type
Form FTDC Form FTDC Form Form and Instruction
FTDC Form FTDC Form Attachment_A_FDTC_COLLECTION FORM1_2-18-15 (3).doc Form and Instruction

Information Collection (IC) Details

IC Title:	FTDC Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

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	FTDC Form	FTDC Form	Attachment_A_FDTC_COLLECTION FORM1_2-18-15 (3).doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	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
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	320	320
Annual IC Cost Burden (Dollars)	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.