View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Annual Reports for PATH)	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 and Instruction	Annua lReport Manual	Annual Report Manual	Attachment A-AnnualReportManual_March2015.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 548	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	548	0	-11	0	0	559
Annual IC Time Burden (Hours)	10,960	0	0	-7,206	0	18,166
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Data Advisory Committee Members Consulted	Attachment C Data Advisory Committee Members Consulted.pdf	09/26/2012
Comments	Attachment D Comments.pdf	09/26/2012
SAMHSA's Responses	Attachment E SAMHSA's Response to the Comments.pdf	09/26/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.