Form SMA 111-2 Form SMA 111-2 Form SMA 111-2

Obligated Service for Mental Health Traineeships: Regulations and Forms

clinical 4-5-07PBS

Obligated Service for Mental Health Traineeships: Regulations and Forms

OMB: 0930-0074

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Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond
to, a collection of information unless it displays a currently valid OMB control number. The OMB control
number for this project is 0930-0074. Public reporting burden for this collection of information is
estimated to average .18 hours per client per year, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance
Officer, 1 Choke Cherry Road, Room 7-1044, Rockville, Maryland, 20857.


File Typeapplication/pdf
File TitlePPCUE0001
File Modified2007-04-05
File Created0000-01-01

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