Information Collection

Crisis Center Survey

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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	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 %

table that charts list of burden
	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

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.