Information Collection

National Evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program: Phase Four

IC 7672 under ICR 200704-0930-002 · OMB 0930-0257.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachment 4 National Evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program: Phase Four	Form and Instruction
Attachment 4 Attachment 4 Attachment 4 - Surveys.ZIP	Form and Instruction
Attachments 1, 2, 3, 5, 6.ZIP Attachments 1, 2, 3, 5, 6	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Attachment 4	Attachment 4	Attachment 4 - Surveys.ZIP		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,374

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	11,539	-39,754	51,293
Annual IC Time Burden (Hours)	6,281	-18,981	25,262
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachments 1, 2, 3, 5, 6	Attachments 1, 2, 3, 5, 6.ZIP

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.