Information Collection

Community Mental Health Services Block Grant Application Guidance and Instructions, FY 2009-2011

IC 7545 under ICR 200805-0930-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 - App Community Mental Health Services Block Grant Application Guidance and Instructions, FY 2009-2011	Form and Instruction
Attachment 4 - App Attachment 4 - Application Attachment-4-FINAL Application 4-4 No Watermark.doc	Form and Instruction
Attachment-5-Commissioner Transmittal Ltr OMB Final.doc Attachment 5 - Letter	IC Document
Attachments-1-3.doc Attachment 1-3 - Comments	IC Document

IC Title:

Community Mental Health Services Block Grant Application Guidance and Instructions, FY 2009-2011

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 - Application	Attachment 4 - Application	Attachment-4-FINAL Application 4-4 No Watermark.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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	59	0	59
Annual IC Time Burden (Hours)	15,710	-885	16,595
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 5 - Letter	Attachment-5-Commissioner Transmittal Ltr OMB Final.doc	05/05/2008
Attachment 1-3 - Comments	Attachments-1-3.doc	05/05/2008

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