Information Collection

Child and Adolescent Psychiatric Assessment : Child Version

IC 196125 under ICR 201102-0920-008 · OMB 0920-0884.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 13 Child and Adolescent Psychiatric Assessment : Child Version Child and Adolescent Psychiatric Assessment : Child Version	Form and Instruction
Form 14 Child and Adolescent Psychiatric Assessment : Child Version Child and Adolescent Psychiatric Assessment : Child Version	Form and Instruction
Form 15 Child and Adolescent Psychiatric Assessment : Child Version Child and Adolescent Psychiatric Assessment : Child Version	Form and Instruction
Form 16 Child and Adolescent Psychiatric Assessment : Child Version Child and Adolescent Psychiatric Assessment : Child Version	Form and Instruction
13 Child and Adolescent Psychiatric Assessment : Child Vers Att E 1 CAPA (Child) E1-E50.pdf	Form and Instruction
14 Child and Adolescent Psychiatric Assessment : Child Vers Att E 2 CAPA (Child) pp E51 - E100.pdf	Form and Instruction
15 Child and Adolescent Psychiatric Assessment : Child Vers Att E 3 CAPA (Child) pp E101 - E150.pdf	Form and Instruction
16 Child and Adolescent Psychiatric Assessment : Child Vers Att E 4 CAPA (Child) E151 - E203.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	13	Yes	Yes	Fillable Fileable
Form and Instruction	14	Yes	Yes	Fillable Fileable
Form and Instruction	15	Yes	Yes	Fillable Fileable
Form and Instruction	16	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U. S. Population

FR Citation: 49 FR 37693

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	225	225
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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