Information Collection

CMHS Program-Level Data

IC 213385 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⚠️ Notice: This information collection may be referencing outdated material.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 IPP_RESULT FORM CMHS Program-Level Data	Form
IPP_RESULT FORM IPP_RESULT FORM Attachment 3 IPP_RESULT FORM.docx	Form

IC Title:

CMHS Program-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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	IPP_RESULT FORM	IPP_RESULT FORM	Attachment 3 IPP_RESULT FORM.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 982

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	3,928	3,928
Annual IC Time Burden (Hours)	7,856	7,856
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.