Client-level interview-Physical Health Indicators

Primary and Behavioral Health Care Integration Program

OMB: 0930-0340

IC ID: 196135

Information Collection (IC) Details

View Information Collection (IC)

Client-level interview-Physical Health Indicators
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Physical Health Indicators Physical Health Indicators Attachment 1 Physical Health Indicators 8 12 2014.pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

 

14,000 0
   
State, Local, and Tribal Governments
 
   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 28,000 0 -28,000 0 0 56,000
Annual IC Time Burden (Hours) 2,240 0 -2,427 0 0 4,667
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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