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

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Protection and Advocacy for Assistive Individuals with Traumatic Brain Injury (PATBI) Program Performance Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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 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 %

	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

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.