Form 13 SHIP Activity Form

SHIP ACTIVITY FORM
NAME:		OMB Control Number 0985-0040 Expiration: Month/Date/2023
PARTNER ORGANIZATION AFFILIATION:
		Please enter time spent on the following activities:
Month	Year	Administrative Support (minutes)	SHIP Program Management/Team Member Management (minutes)	Other SHIP Activities (minutes)	Total (minutes) Note: This will sum the previous 3 columns.
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Public Burden Statement: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number (OMB 0985-0040). Public reporting burden for this collection of information averages 7 minutes per response, including time for gathering, maintaining, completing and reviewing the collection of information. The obligation to respond to this collection is required to retain or maintain benefits under the statutory authority from Section 4360(f) of the OBRA.					0
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