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AIDS Drug Assistance Program Quarterly Report
HRSA AIDS Drug Assistance Quarterly Report
OMB: 0915-0294
IC ID: 6549
OMB.report
HHS/HSA
OMB 0915-0294
ICR 201402-0915-006
IC 6549
( )
Documents and Forms
Document Name
Document Type
Form 1
AIDS Drug Assistance Program Quarterly Report
Form
1 ADAP Quarterly Report
B - AQR Form.doc
Form
C - AQR Instructions 2014.docx
C - AQR Instructions 2014
IC Document
D - AQR Screenshots 2014.docx
D - AQR Screenshots 2014
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
AIDS Drug Assistance Program 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
Federal Enterprise Architecture Business Reference Module
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
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
57
0
-171
0
0
228
Annual IC Time Burden (Hours)
969
0
0
541
0
428
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
C - AQR Instructions 2014
C - AQR Instructions 2014.docx
02/20/2014
D - AQR Screenshots 2014
D - AQR Screenshots 2014.docx
03/26/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.