Information Collection

Crisis Center Survey

IC 196808 under ICR 201103-0930-002 · OMB 0930-0324.

Documents and Forms

Document Name Document Type
Form Crisis Center Surv Crisis Center Survey Form and Instruction
Crisis Center Surv Crisis Center Survey Crisis Center Survey 053111_FINAL_VERSION.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Crisis Center Survey	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	Crisis Center Survey	Crisis Center Survey	Crisis Center Survey 053111_FINAL_VERSION.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 147	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	147	147
Annual IC Time Burden (Hours)	111	111
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.