Information Collection

Ryan White Services Report Manual

IC 233865 under ICR 202111-0906-001 · OMB 0906-0039.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0039 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Ryan White Services Report Manual Form and Instruction
1 2021_DRAFT RSR_Manual.pdf Tab B 2021_DRAFT RSR_Manual.pdf Form and Instruction
1 2021_DRAFT RSR_Manual.pdf Tab B 2021_DRAFT RSR_Manual.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Ryan White Services Report Manual	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
Form and Instruction	1	2021_DRAFT RSR_Manual.pdf	Tab B 2021_DRAFT RSR_Manual.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,190	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	4,190	3,715	475
Annual IC Time Burden (Hours)	206,480	201,255	5,225
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.