Information Collection

Adult Treatment Drug Court Cross-Site Evaluation - Correction MH Screener for Men

IC 190677 under ICR 200909-0930-002 · OMB 0930-0306.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachments A-F In Adult Treatment Drug Court Cross-Site Evaluation - Correction MH Screener for Men	Form and Instruction
Attachments A-F In Attachments A-F Instruments Attachments A-F Instruments.zip	Form and Instruction
Attachments G-M.zip Attachments G-M Other	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form?

IC Status: New

Obligation to Respond: Voluntary

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	Attachments A-F Instruments	Attachments A-F Instruments	Attachments A-F Instruments.zip		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 408

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	408	408
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachments G-M Other	Attachments G-M.zip	09/08/2009

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