Grantee Data Staff -TRAC Indicators

Evaluation of SAMHSA Primary Care Behavioral Health Integration Grant Program

Documents and Forms

Document Name Document Type
0990-0371Attach 9 Additions to TRAC.doc Other-surve

Information Collection (IC) Details

IC Title:	Grantee Data Staff -TRAC Indicators	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Other-surve			0990-0371Attach 9 Additions to TRAC.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	56,000	44,000	12,000
Annual IC Time Burden (Hours)	4,667	3,707	960
Annual IC Cost Burden (Dollars)	0	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.