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Ryan White Services Report Service Provider Report
Ryan White HIV/AIDS Program Client-Level Data Reporting System
OMB: 0906-0039
IC ID: 233866
OMB.report
HHS/HRSA
OMB 0906-0039
ICR 201909-0906-005
IC 233866
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0039 can be found here:
2024-07-16 - Revision of a currently approved collection
2021-11-16 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 2
Ryan White Services Report Service Provider Report
Form
2 2018_Service_Provider_Form_Screenshots
C - 2018_Service_Provider_Form_Screenshots_4242018_updated_final_RSR Instrument.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Ryan White Services Report Service Provider Report
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
2
2018_Service_Provider_Form_Screenshots
C - 2018_Service_Provider_Form_Screenshots_4242018_updated_final_RSR Instrument.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
2,079
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 New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
2,079
0
0
0
0
2,079
Annual IC Time Burden (Hours)
27,027
0
0
0
0
27,027
Annual IC Cost Burden (Dollars)
0
0
0
0
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.