OMB
.report
Search
Obligated Service for Mental Health Traineeships: Regulations and Forms
Obligated Service for Mental Health Traineeships: Regulations and Forms
OMB: 0930-0074
IC ID: 111885
OMB.report
HHS/SAMHSA
OMB 0930-0074
ICR 199412-0930-003
IC 111885
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0074 can be found here:
2007-04-19 - Revision of a currently approved collection
2004-01-20 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Obligated Service for Mental Health Traineeships: Regulations and Forms
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
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
111
Yes
Yes
Form
111-2
Yes
Yes
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
350
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
15 %
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
350
0
146
204
0
0
Annual IC Time Burden (Hours)
55
0
-66
-92
0
213
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.