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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

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	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 %

table that charts list of burden
	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

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.