MH Provider Interview

Evaluation of SAMHSA Primary Care Behavioral Health Integration Grant Program

OMB: 0990-0371

IC ID: 196132

Documents and Forms
Document Name
Document Type
Other-interview
Information Collection (IC) Details

View Information Collection (IC)

MH Provider Interview
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-interview 0990-PCBHI Attach 6 Client exam and survey.doc No No Printable Only

Health Illness Prevention

 

9 0
   
Individuals or Households
 
   0 %

  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 9 0 9 0 0 0
Annual IC Time Burden (Hours) 9 0 9 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

© 2024 OMB.report | Privacy Policy