Information Collection

Client Report

IC 269447 under ICR 202506-0906-004 · OMB 0906-0039.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3 Client Level Data on File Client Report	Form and Instruction
Form 3 Ryan White Services Report_ Client Level Data on File_ OMB 0906-0039_06.13.2025 (Redline).docx	Other-Redline
Form 3 Ryan White Services Report_ Client Level Data on File_ OMB 0906-0039_06.13.2025 (Redline).docx	Other-Redline
3 Client Level Data on File Form 3 Ryan White Services Report_ Client Level Data on File_ OMB 0906-0039_06.13.2025 (Clean).docx	Form and Instruction
3 Client Level Data on File Form 3 Ryan White Services Report_ Client Level Data on File_ OMB 0906-0039_06.13.2025 (Clean).docx	Form and Instruction

IC Title:

Client Report

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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-Redline					Yes	Yes	Fillable Fileable
Form and Instruction	3				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,532

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	1,532	1,532
Annual IC Time Burden (Hours)	173,116	173,116
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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