Information Collection

Tier 1 Supportive Services

IC 260555 under ICR 202503-0937-001 · OMB 0937-0213.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0937-0213 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
TPP23 Supportive Services Tier 1.docx	Other-survey
TPP23 Supportive Services Tier 1.docx	Other-survey

IC Title:

Tier 1 Supportive Services

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
Other-survey					Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 70

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	140	140
Annual IC Time Burden (Hours)	35	35
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.

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