PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
SHIP Activity Form
New
8640
1008
0
Form and Instruction
13
SHIP Activity Form
SHIP/MIPPA Beneficiary Client Form
Modified
3495000
291250
0
Form and Instruction
1
Beneficiary Contact Form
SHIP/MIPPA Media Outreach Education Form
Modified
56250
3750
0
Form and Instruction
2
Media Outreach Education Form
SHIP/MIPPA Group Outreach Education Form
Modified
56250
3750
0
Form and Instruction
4
Group Outreach and Education Form
SHIP/MIPPA Team Member Form
Modified
16200
1008
0
Form and Instruction
3
Team Member Form
SIRS Individual Interaction-Complex Form
New
13870
1156
0
Form and Instruction
12
SIRS Individual Interaction-Complex Form
SIRS Team Member Form
New
6696
558
0
Form and Instruction
11
SIRS Team Member Form
SMP Group Outreach & Education
New
27740
1849
0
Form and Instruction
8
SMP Group Outreach and Education
SMP Individual Interaction-Basic
New
284335
23695
0
Form and Instruction
9
SMP Individual Interaction Basic Interaction Form
SMP Media Outreach & Education
New
9936
662
0
Form and Instruction
7
SMP Media Outreach and Education Form
SMP Team Member Form
New
6696
558
0
Form and Instruction
10
SMP Team Member Form
Total burden requested under this ICR:
3981613
329244
0
To view an IC, click on IC Title
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