RWHAP UOB Tables Summary

Information Collection Request Title: Ryan White HIV/AIDS Program (RWHAP) Parts A and B Unobligated Balances and Rebate Addendum Tables.

Documents and Forms

Document Name Document Type
Form 1 RWHAP UOB Tables Summary Form
1 Part A UOB Table Part A Instrument.docx Form
1 Part A UOB Table Part A Instrument.docx Form
2 Part B UOB Table Part B Instrument.docx Form and Instruction
2 Part B UOB Table Part B Instrument.docx Form and Instruction

Information Collection (IC) Details

IC Title:	RWHAP UOB Tables Summary	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Part A UOB Table	Part A Instrument.docx		Yes	Yes	Fillable Fileable
Form and Instruction	2	Part B UOB Table	Part B Instrument.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 111	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	111	111
Annual IC Time Burden (Hours)	56	56
Annual IC Cost Burden (Dollars)	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.