Web-based Surveys

Independent Evaluation of the Community Mental Health Services Block Grant

Documents and Forms

Document Name Document Type
Form Surveys Web-based Surveys Form and Instruction
Surveys Surveys Surveys.zip Form and Instruction
Letters.zip Letters IC Document

Information Collection (IC) Details

IC Title:	Web-based Surveys	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

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,063	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 Agency Discretion
Annual Number of Responses for this IC	2,063	2,063
Annual IC Time Burden (Hours)	2,063	2,063
Annual IC Cost Burden (Dollars)	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.