Information Collection

CL Lifespan Respite Program Grantee Performance Measurement Reporting Tool

IC 258607 under ICR 202302-0985-006 · OMB 0985-0076.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CL Lifespan Respite Program Grantee Performance Measurement Reporting Tool	Form
0985New ACL Lifespan Respite Data Definitions 508 compliant.pdf	Instruction
0985New ACL Lifespan Respite Data Definitions 508 compliant.pdf	Instruction
Lifespan Respite Grantee PPR 0985New ACL Lifespan Respite Data Elements 508 compliant.pdf	Form
Lifespan Respite Grantee PPR 0985New ACL Lifespan Respite Data Elements 508 compliant.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	Lifespan Respite Grantee PPR	0985New ACL Lifespan Respite Data Elements 508 compliant.pdf		Yes	Yes	Fillable Fileable
Instruction			0985New ACL Lifespan Respite Data Definitions 508 compliant.pdf		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: 40

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	80	80
Annual IC Time Burden (Hours)	480	480
Annual IC Cost Burden (Dollars)	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.