Information Collection

Title X Grant Requirements

IC 249923 under ICR 202110-0937-005 · OMB 0937-0211.

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Document Name	Document Type

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IC Title:

Title X Grant Requirements

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 59

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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Title X Grant Requirements

FR Citation: 86 FR 56144

Number of Respondents: 136

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	136	136
Annual IC Time Burden (Hours)	9,520	9,520
Annual IC Cost Burden (Dollars)	7,530	7,530

Documents for IC

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Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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