Information Collection

Alzheimer's Disease Supportive Services Program (ADSSP) Data Collection

IC 178976 under ICR 202010-0985-003 · OMB 0985-0022.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0985-0022 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0022 ADP-DRT Data Collection Tool Terms 100620.docx	Instruction
ADSSP IC Tool 0022 ADSSP IC Tool 2020 IC ext.xlsx	Form

IC Title:

Alzheimer's Disease Supportive Services Program (ADSSP) Data Collection

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
Instruction			0022 ADP-DRT Data Collection Tool Terms 100620.docx		Yes	Yes	Fillable Fileable
Form	NA	ADSSP IC Tool	0022 ADSSP IC Tool 2020 IC ext.xlsx		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: 270

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	540	312	228
Annual IC Time Burden (Hours)	2,329	1,346	983
Annual IC Cost Burden (Dollars)	0	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.