Information Collection

Aims 1&2 Clinic Assessment (every 6 months)

IC 263138 under ICR 202601-0920-013 · OMB 0920-1423.

Documents and Forms

Document Name Document Type
Aims 1&2 Clinic Assessment (every 6 months) Form and Instruction
Aims 1&2 Clinic Assessment (every 6 months) Aims 1&2 Clinic Assessment (every 6 months) Form and Instruction
Aims 1&2 Clinic Assessment (every 6 months) Att 4s_Aim1&2 Clinic Assessment Every 6 Mos_Clean.docx Form and Instruction
Aims 1&2 Clinic Assessment (every 6 months) Att 4s_Aim1&2 Clinic Assessment Every 6 Mos_Clean.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Aims 1&2 Clinic Assessment (every 6 months)	Agency IC Tracking Number:	0920-22GA

Is this a Common Form? No		IC Status: Modified

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
Form and Instruction	n/a	Aims 1&2 Clinic Assessment (every 6 months)	Att 4s_Aim1&2 Clinic Assessment Every 6 Mos_Clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	14	5	9
Annual IC Time Burden (Hours)	24	-3	27
Annual IC Cost Burden (Dollars)	0	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.

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