HRSA AIDS Drug Assistance Quarterly Report

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0294 can be found here:

Documents and Forms

Document Name Document Type
Form 1 HRSA AIDS Drug Assistance Quarterly Report Form
C - AQR Instructions_revised_3.18.11.docx Instruction
1 ADAP Quarterly Report B - AQR Form.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	HRSA AIDS Drug Assistance Quarterly 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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	ADAP Quarterly Report	B - AQR Form.doc		Yes	Yes	Fillable Fileable
Instruction			C - AQR Instructions_revised_3.18.11.docx		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 57	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	228	228
Annual IC Time Burden (Hours)	428	428
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.