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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
TPP23 Supportive Services Tier 1.docx Other-survey
TPP23 Supportive Services Tier 1.docx Other-survey

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-survey			TPP23 Supportive Services Tier 1.docx		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 %

	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

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.