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SPF-SIG - Community
Strategic Prevention Framework State Incentive Grant (SPF SIG) Program
OMB: 0930-0279
IC ID: 191137
OMB.report
HHS/SAMHSA
OMB 0930-0279
ICR 201311-0930-001
IC 191137
( )
Documents and Forms
Document Name
Document Type
Form CLI Part I
SPF-SIG - Community
Form and Instruction
CLI Part I CLI Part I
A1c - CLI Part I 7-22-13.doc
Form and Instruction
CLI Part II CLI Part II
A1d - CLI Part II 7-22-13.doc
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
SPF-SIG - Community
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
CLI Part I
CLI Part I
A1c - CLI Part I 7-22-13.doc
Yes
Yes
Fillable Printable
Form and Instruction
CLI Part II
CLI Part II
A1d - CLI Part II 7-22-13.doc
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:
510
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
10,710
0
10,710
0
0
0
Annual IC Time Burden (Hours)
5,738
0
5,738
0
0
0
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.