Information Collection

Traumatic Brain Injury (TBI) State Partnership Program

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Traumatic Brain Injury (TBI) State Partnership Program	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	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 %

	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

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.