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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.