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Community Mental Health Center Site Visit Assessment Tool and Supporting Regulations in 42 CFR 410.2
Community Mental Health Center Site Visit Assessment Tool and Supporting Regulations in 42 CFR 410.2
OMB: 0938-0770
IC ID: 8516
OMB.report
HHS/CMS
OMB 0938-0770
ICR 200508-0938-002
IC 8516
( )
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:
Community Mental Health Center Site Visit Assessment Tool and Supporting Regulations in 42 CFR 410.2
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
CMS-R-273
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
4,731
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
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
4,731
0
0
181
0
4,550
Annual IC Time Burden (Hours)
20,372
0
0
2,972
0
17,400
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.