Information Collection

Application

IC 7545 under ICR 201106-0930-001 · OMB 0930-0168.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0168 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form MH Reporting Secti Application	Form and Instruction
MH Reporting Secti MH Reporting Section MH Reporting Section 6-16-11.pdf	Form and Instruction
SA_Reporting _Sect SA_Reporting _Section SA_Reporting _Section_6-16-11.pdf	Form and Instruction
BG_Planning_Sectio BG_Planning_Section BG_Planning_Section_6-17-19 FINAL.pdf	Form and Instruction
Attachment B - Public Comments.docx Attachment B - Public Comments	IC Document
Attachment C - Summary of Block Grant Public Comments 6-17-11 final.docx Attachment C - Summary of Public Comments	IC Document

IC Title:

Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	MH Reporting Section	MH Reporting Section	MH Reporting Section 6-16-11.pdf	Yes	Yes	Paper Only
Form and Instruction	SA_Reporting _Section	SA_Reporting _Section	SA_Reporting _Section_6-16-11.pdf	Yes	Yes	Paper Only
Form and Instruction	BG_Planning_Section	BG_Planning_Section	BG_Planning_Section_6-17-19 FINAL.pdf	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 119

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	Previously Approved
Annual Number of Responses for this IC	119	60	59
Annual IC Time Burden (Hours)	37,429	21,719	15,710
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment B - Public Comments	Attachment B - Public Comments.docx	06/17/2011
Attachment C - Summary of Public Comments	Attachment C - Summary of Block Grant Public Comments 6-17-11 final.docx	06/17/2011

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