Information Collection

988 Lifeline Administrator

IC 260138 under ICR 202312-0930-001 · OMB 0930-0394.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0394 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Lifeline Key Metri 988 Lifeline Administrator	Form and Instruction
Lifeline Key Metri Lifeline Key Metrics (Monthly) 988 Lifeline Instrument 1 _ Monthly & Ad Hoc Lifeline Key Metrics 4.5.23.docx	Form and Instruction
Lifeline Key Metri Lifeline Key Metrics (Monthly) 988 Lifeline Instrument 1 _ Monthly & Ad Hoc Lifeline Key Metrics 4.5.23.docx	Form and Instruction
Lifeline Monthly P Lifeline Monthly Progress Reports 988 Lifeline Instrument 2 _ Monthly Progress Reports 4.5.23.docx	Form and Instruction
Lifeline Monthly P Lifeline Monthly Progress Reports 988 Lifeline Instrument 2 _ Monthly Progress Reports 4.5.23.docx	Form and Instruction

IC Title:

988 Lifeline Administrator

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

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 and Instruction	Lifeline Key Metrics (Monthly)	Lifeline Key Metrics (Monthly)	988 Lifeline Instrument 1 _ Monthly & Ad Hoc Lifeline Key Metrics 4.5.23.docx		Yes	Yes	Fillable Fileable
Form and Instruction	Lifeline Monthly Progress Reports	Lifeline Monthly Progress Reports	988 Lifeline Instrument 2 _ Monthly Progress Reports 4.5.23.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Privacy Act of 1974 (Title 5 United States Code [U.S.C.] 552a)

FR Citation: 75 FR 28264

Number of Respondents: 2

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	Previously Approved
Annual Number of Responses for this IC	24	24
Annual IC Time Burden (Hours)	186	186
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.