HRSA Client-Level Data Reporting System: Client Report

HRSA HAB Client-Level Data Reporting System

Documents and Forms

Document Name Document Type
Form D HRSA Client-Level Data Reporting System: Client Report Form
D D- 2017 RSR Client Level Data Elements_Final 4-22-17_OMB D- 2017 RSR Client Level Data Elements_Final 4-22-17_OMB (002).docx Form

Information Collection (IC) Details

IC Title:	HRSA Client-Level Data Reporting System: Client Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	D	D- 2017 RSR Client Level Data Elements_Final 4-22-17_OMB (002).docx	D- 2017 RSR Client Level Data Elements_Final 4-22-17_OMB (002).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,312	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	1,312	1,312
Annual IC Time Burden (Hours)	87,904	87,904
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.