Information Collection

The Nat'l Eval. of theComprehensive Community MH Services for Children - Providers/Administrators

IC 190422 under ICR 201206-0930-002 · OMB 0930-0307.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0307 can be found here:

Documents and Forms

Document Name Document Type
Form Provider Administr The Nat'l Eval. of theComprehensive Community MH Services for Children - Providers/Administrators Form and Instruction
Provider Administr Provider Administrator-Instruments Provider Administrator--Instruments.pdf Form and Instruction
Provider Administrator--Other.pdf Provider Administrator--Other IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	The Nat'l Eval. of theComprehensive Community MH Services for Children - Providers/Administrators	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
Form and Instruction	Provider Administrator-Instruments	Provider Administrator-Instruments	Provider Administrator--Instruments.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,081	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	Previously Approved
Annual Number of Responses for this IC	134,452	-20,226	154,678
Annual IC Time Burden (Hours)	12,539	3,741	8,798
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Provider Administrator--Other	Provider Administrator--Other.pdf	09/10/2012

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