ALCOHOLIC TREATMENT CENTER QUESTIONNAIRE

ICR 197612-0930-001

OMB: 0930-0003

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
111788 Migrated
ICR Details
0930-0003 197612-0930-001
Historical Active 197508-0930-001
HHS/SAMHSA
ALCOHOLIC TREATMENT CENTER QUESTIONNAIRE
Revision of a currently approved collection   No
Regular
Approved without change 01/11/1977
Retrieve Notice of Action (NOA) 12/07/1976
  Inventory as of this Action Requested Previously Approved
12/31/1977 12/31/1977 12/31/1976
312,000 0 286,000
25,000 0 22,880
0 0 0



None
None


No

1
IC Title Form No. Form Name
ALCOHOLIC TREATMENT CENTER QUESTIONNAIRE NIMH1009

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 312,000 286,000 0 0 26,000 0
Annual Time Burden (Hours) 25,000 22,880 0 0 2,120 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
12/07/1976


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