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FASD P-CAP Client Lost Post Exit
Fetal Alcohol Spectrum Disorder (FASD) Center for Excellence Parent-Child Assistance Program (P-CAP)
OMB: 0930-0309
IC ID: 191220
OMB.report
HHS/SAMHSA
OMB 0930-0309
ICR 200911-0930-001
IC 191220
( )
Documents and Forms
Document Name
Document Type
Form Client Lost Post E
FASD P-CAP Client Lost Post Exit
Form and Instruction
Client Lost Post E Client Lost Post Exit
11 Client Lost Post Exit.pdf
Form and Instruction
Attachment II and III.zip
Attachment II and III
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
FASD P-CAP Client Lost Post Exit
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Voluntary
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
Client Lost Post Exit
Client Lost Post Exit
11 Client Lost Post Exit.pdf
Yes
Yes
Paper Only
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:
29
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
29
0
29
0
0
0
Annual IC Time Burden (Hours)
7
0
7
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Attachment II and III
Attachment II and III.zip
10/27/2009
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.