Information Collection

Protection and Advocacy for Assistive Individuals with Traumatic Brain Injury (PATBI) Program Performance Report

IC 226890 under ICR 201705-0985-001 · OMB 0985-0058.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Protection and Advocacy for Assistive Individuals with Traumatic Brain Injury (PATBI) Program Performance Report	Form and Instruction
1 PATBI Program Performance Report PATBI-PPR-Template with Burden Statement.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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	1	PATBI Program Performance Report	PATBI-PPR-Template with Burden Statement.docx		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: 57

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	57	57
Annual IC Time Burden (Hours)	912	912
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.