Information Collection

Community Mental Health Services Block Grant Application Guidance and Instructions, FY 2005-2007

IC 7545 under ICR 200706-0930-001 · OMB 0930-0168.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0168 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachment 4 Community Mental Health Services Block Grant Application Guidance and Instructions, FY 2005-2007	Form and Instruction
Attachment 4 2008-2010 Application Attachment4-BG Application with Data Tables 05 28 07pm Final 1.doc	Form and Instruction
Attachment5-Commissioner Transmittal Ltr OMB Final.doc Attachment 5 - Transmittal Letter	IC Document

IC Title:

Community Mental Health Services Block Grant Application Guidance and Instructions, FY 2005-2007

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	2008-2010 Application	Attachment4-BG Application with Data Tables 05 28 07pm Final 1.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 59

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 59 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	59	0	59
Annual IC Time Burden (Hours)	16,595	-670	17,265
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 5 - Transmittal Letter	Attachment5-Commissioner Transmittal Ltr OMB Final.doc	06/06/2007

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