Information Collection

Parent Program Manager TA Tracking Form

IC 206024 under ICR 201512-0920-010 · OMB 0920-0941.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Parent Program Manager TA Tracking Form	Form
Parent Program Manager (PPM) Technical Assistance Tracki Atmt LLLL - Parent_Program_Manager_TA_Tracking_ Form.docx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	none	Parent Program Manager (PPM) Technical Assistance Tracking form	Atmt LLLL - Parent_Program_Manager_TA_Tracking_ Form.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 20 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-200	200
Annual IC Time Burden (Hours)	-33	33
Annual IC Cost Burden (Dollars)	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.