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Trac
Co-location and Integration of HIV Prevention and Medical Care into Behavioral Health Program
OMB: 0930-0343
IC ID: 212087
OMB.report
HHS/SAMHSA
OMB 0930-0343
ICR 201510-0930-003
IC 212087
( )
Documents and Forms
Document Name
Document Type
Form TRAC
TRAC
Form and Instruction
TRAC TRAC
Attachment 2 TRAC 6 17 2014.pdf
Form and Instruction
Attachment 4 Composition of Proposed CoC TRACTool.docx
Composition of Proposed CoC TRAC Tool
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
TRAC
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Removed
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
TRAC
TRAC
Attachment 2 TRAC 6 17 2014.pdf
Yes
Yes
Fillable Printable
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:
1,200
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
0
0
-2,196
0
0
2,196
Annual IC Time Burden (Hours)
0
0
-397
0
0
397
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Composition of Proposed CoC TRAC Tool
Attachment 4 Composition of Proposed CoC TRACTool.docx
06/26/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.