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ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Alzheimer's Disease Supportive Services Program (ADSSP) Data Collection
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
1
Proposed Alzheimer Disease Prevention Reporting Tool
0985-0022 Proposed ADP-DRT Data Collection Tool Updated 6.21.17v2.xlsx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Social Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
114
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
228
0
134
0
0
94
Annual IC Time Burden (Hours)
983
0
-427
0
0
1,410
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
ADSSP Definitions
2 of 3 ADSSP Definitions for Data Collection.doc
05/20/2010
Draft Definition of Terms for OMB
Draft Definition of Terms for OMB Data.docx
12/30/2016
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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