Information Collection

AIDS Drug Assistance Program (ADAP) Data Report (ADR)

IC 199933 under ICR 202004-0915-002 · OMB 0915-0345.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0345 can be found here:

Documents and Forms

Document Name Document Type
Form 1 AIDS Drug Assistance Program (ADAP) Data Report (ADR) Form and Instruction
1 ADR variable changes Instrument.pdf ADR variable changes Instrument.pdf Form and Instruction
2 ADR 2020 EHE Question in Recipient Report.docx ADR 2020 EHE Question in Recipient Report.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	AIDS Drug Assistance Program (ADAP) Data Report (ADR)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 and Instruction	1	ADR variable changes Instrument.pdf	ADR variable changes Instrument.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	2	ADR 2020 EHE Question in Recipient Report.docx	ADR 2020 EHE Question in Recipient Report.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	54	54
Annual IC Time Burden (Hours)	4,698	4,698
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.