Information Collection

Traumatic Brain Injury (TBI) State Partnership Program

IC 239261 under ICR 202302-0985-003 · OMB 0985-0066.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Traumatic Brain Injury (TBI) State Partnership Program	Form
0066 TBI_PPR_Tool_Guidance.pdf	Instruction
0066 TBI_PPR_Tool_Guidance.pdf	Instruction
TBI PPR 0066 TBI_PPR_Revisions Cover Sheet.pdf	Form
TBI PPR 0066 TBI_PPR_Revisions Cover Sheet.pdf	Form

IC Title:

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
Form	NA	TBI PPR	0066 TBI_PPR_Revisions Cover Sheet.pdf		Yes	Yes	Fillable Fileable
Instruction			0066 TBI_PPR_Tool_Guidance.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 29

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	58	4	54
Annual IC Time Burden (Hours)	464	32	432
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.