Information Collection

SUPRT-Client

IC 272841 under ICR 202505-0930-003 · OMB 0930-0400.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SUPRT-Client SUPRT-Client	Form and Instruction
Form SUPRT-Client SUPRT-Client SUPRT-Client	Form and Instruction
SUPRT-Client SUPRT-Client SUPRT-Client-Clean 022825.docx	Form and Instruction
SUPRT-Client SUPRT-Client SUPRT-Client-Clean 022825.docx	Form and Instruction

IC Title:

SUPRT-Client

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	SUPRT-Client				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: SUPRT Client

FR Citation: 75 FR 28264

Number of Respondents: 1,062,196

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	1,062,196	1,062,196
Annual IC Time Burden (Hours)	203,087	203,087
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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