Ryan White Comprehensive Aids Resources Emergency (CARE) Act and Minority Aids Initiative (MAI) Consultation Form

ICR 200308-0915-003

OMB: 0915-0280

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0915-0280 200308-0915-003
Historical Active
HHS/HSA
Ryan White Comprehensive Aids Resources Emergency (CARE) Act and Minority Aids Initiative (MAI) Consultation Form
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 11/05/2003
Retrieve Notice of Action (NOA) 08/19/2003
Approved, on the condition that HRSA adds the OMB number, burden statement and expiration date to the form immediately.
  Inventory as of this Action Requested Previously Approved
10/31/2004 10/31/2004
1,500 0 0
500 0 0
0 0 0

The Consultation Form will be used to collect information from grantees and their subcontracted service providers funded by the Minority AIDS Initiative (MAI).

None
None


No

1
IC Title Form No. Form Name
Ryan White Comprehensive Aids Resources Emergency (CARE) Act and Minority Aids Initiative (MAI) Consultation Form

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,500 0 0 1,500 0 0
Annual Time Burden (Hours) 500 0 0 500 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
08/19/2003


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