Information Collection

Program attendance and content coverage protocol

IC 215077 under ICR 201701-0990-003 · OMB 0990-0428.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-NEW_ PAF Instrument 5_Program Attendance Data Collection Protocol.docx	Other-Data
0990-New-PAF Attachment D_Confidentiality Pledge.pdf Confidentiality Pledge	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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
Other-Data			0990-NEW_ PAF Instrument 5_Program Attendance Data Collection Protocol.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	24	24
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Confidentiality Pledge	0990-New-PAF Attachment D_Confidentiality Pledge.pdf	02/24/2015

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