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Targeted Capacity Expansion Grants for Jail Diversion Programs - Service Use
Targeted Capacity Expansion Grants for Jail Diversion Programs
OMB: 0930-0277
IC ID: 190660
OMB.report
HHS/SAMHSA
OMB 0930-0277
ICR 201209-0930-002
IC 190660
( )
Documents and Forms
Document Name
Document Type
Form Service Use Data C
Targeted Capacity Expansion Grants for Jail Diversion Programs - Service Use
Form and Instruction
Service Use Data C Service Use Data Collection Form
F Service Use Data Collection Form 12.27.12.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Targeted Capacity Expansion Grants for Jail Diversion Programs - Service Use
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
Service Use Data Collection Form
Service Use Data Collection Form
F Service Use Data Collection Form 12.27.12.pdf
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
10
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 New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
500
0
0
-23
0
523
Annual IC Time Burden (Hours)
85
0
0
-3
0
88
Annual IC Cost Burden (Dollars)
0
0
0
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.