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Interviews
Independent Evaluation of the Community Mental Health Services Block Grant
OMB: 0930-0289
IC ID: 181871
OMB.report
HHS/SAMHSA
OMB 0930-0289
ICR 200709-0930-001
IC 181871
( )
Documents and Forms
Document Name
Document Type
Form Surveys
Interviews
Form and Instruction
Surveys Surveys
Surveys.zip
Form and Instruction
Letters.zip
Letters
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Interviews
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Voluntary
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
Surveys
Surveys
Surveys.zip
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
20
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
20
0
20
0
0
0
Annual IC Time Burden (Hours)
20
0
20
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Letters
Letters.zip
08/23/2007
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.