Information Collection

Ta-soc

IC 214987 under ICR 201306-0930-003 · OMB 0930-0196.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0196 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SOC Interview Part TA-SOC	Form and Instruction
SOC Interview Part SOC Interview Participants ATTACHMENT A FINAL.doc	Form and Instruction
Focus Group Partic Focus Group Participants ATTACHMENT B FINAL.doc	Form and Instruction
CMHI Interviews and Focus Group OMB Supporting Statement Final.doc Justification-SS	IC Document
TransLet-1.doc Justification Letter	IC Document

IC Title:

TA-SOC

Agency IC Tracking Number:

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	SOC Interview Participants	SOC Interview Participants	ATTACHMENT A FINAL.doc		Yes	Yes	Fillable Printable
Form and Instruction	Focus Group Participants	Focus Group Participants	ATTACHMENT B FINAL.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 96

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	96	96
Annual IC Time Burden (Hours)	144	144
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification-SS	CMHI Interviews and Focus Group OMB Supporting Statement Final.doc	02/12/2015
Justification Letter	TransLet-1.doc	02/12/2015

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