SMI Clients -Client Exam and Survey-Baseline

Primary and Behavioral Health Care Integration Program

OMB: 0930-0340

IC ID: 196129

Documents and Forms
Document Name
Document Type
Other-survey
Information Collection (IC) Details

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SMI Clients -Client Exam and Survey-Baseline
 
No Removed
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-survey 0990-0371Attach 6 Client exam and survey.doc Yes Yes Fillable Fileable

Health Illness Prevention

 

1,000 0
   
Individuals or Households
 
   0 %

  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 0 0 -1,000 0 0 1,000
Annual IC Time Burden (Hours) 0 0 -750 0 0 750
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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