Information Collection

Obligated Service for Mental Health Traineeships: Regulations and Forms

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

Documents and Forms

Document Name Document Type
Form 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

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: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection 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	Form SMA 111-2	clinical 4-5-07PBS.pdf		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 %

	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

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.