Information Collection

CMHS Client -Level Data

IC 213379 under ICR 201410-0930-001 · OMB 0930-0346.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0346 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMHS Instrument CMHS Client -Level Data	Form and Instruction
PBHCI SECTION H PBHCI SECTION H Attachment 2 PBHCI SECTION H FINAL CDP.pdf	Form and Instruction
CMHS Instrument CMHS Instrument Attachment 1 Final CMHS Instrument 12 19 2014.docx	Form and Instruction
CoC Questions CoC Questions Attachment 8 CoC Questions Final 12 19 2014 .docx	Form and Instruction
Attachment 10 CMHS CSAT Manual 11 19.docx CMHS CSAT Manual	IC Document

IC Title:

CMHS Client -Level Data

Agency IC Tracking Number:

Is this a Common Form? No

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMHS Instrument	CMHS Instrument	Attachment 1 Final CMHS Instrument 12 19 2014.docx	Yes	Yes	Fillable Fileable
Form and Instruction	CoC Questions	CoC Questions	Attachment 8 CoC Questions Final 12 19 2014 .docx	Yes	Yes	Fillable Fileable
Form and Instruction	PBHCI SECTION H	PBHCI SECTION H	Attachment 2 PBHCI SECTION H FINAL CDP.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 35,845

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	98,157	98,157
Annual IC Time Burden (Hours)	33,958	33,958
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMHS CSAT Manual	Attachment 10 CMHS CSAT Manual 11 19.docx	11/19/2014

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