Information Collection

Obligated Service for Mental Health Traineeships: Regulations and Forms

IC 7490 under ICR 200704-0930-009 · OMB 0930-0074.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form SMA 111-2 Form SMA 111-2 Obligated Service for Mental Health Traineeships: Regulations and Forms	Form and Instruction
Form SMA 111-2 Form SMA 111-2 clinical 4-5-07PBS.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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	Form SMA 111-2				No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 57

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	57	-22	79
Annual IC Time Burden (Hours)	10	-4	14
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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