Grantee Data - Individual Service Utilization Data

Primary and Behavioral Health Care Integration Program

OMB: 0930-0340

IC ID: 196136

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

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Grantee Data - Individual Service Utilization Data
 
No Removed
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-survey 0990-0371Attach 7 Client level serivce utilization report.doc Yes Yes Fillable Fileable

Health Illness Prevention

 

56 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 -224 0 0 224
Annual IC Time Burden (Hours) 0 0 -1,792 0 0 1,792
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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