Alzheimer's Disease Supportive Services Program (ADSSP) Data Collection

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0985-0022 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Alzheimer's Disease Supportive Services Program (ADSSP) Data Collection Form
1 Proposed Alzheimer Disease Prevention Reporting Tool 0985-0022 Proposed ADP-DRT Data Collection Tool Updated 6.21.17v2.xlsx Form
2 of 3 ADSSP Definitions for Data Collection.doc ADSSP Definitions IC Document
Draft Definition of Terms for OMB Data.docx Draft Definition of Terms for OMB IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Alzheimer's Disease Supportive Services Program (ADSSP) Data Collection	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Proposed Alzheimer Disease Prevention Reporting Tool	0985-0022 Proposed ADP-DRT Data Collection Tool Updated 6.21.17v2.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 114	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	228	134	94
Annual IC Time Burden (Hours)	983	-427	1,410
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
ADSSP Definitions	2 of 3 ADSSP Definitions for Data Collection.doc	05/20/2010
Draft Definition of Terms for OMB	Draft Definition of Terms for OMB Data.docx	12/30/2016

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