Information Collection

MCHSB Grant Application/Annual Report Guidance

IC 6398 under ICR 201411-0915-001 · OMB 0915-0172.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0172 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 MCHSB Grant Application/Annual Report Guidance	Form and Instruction
1 Guidance and Forms Guidance and Forms.pdf	Form and Instruction

IC Title:

MCHSB Grant Application/Annual Report Guidance

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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 and Instruction	1	Guidance and Forms	Guidance and Forms.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 59

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	Previously Approved
Annual Number of Responses for this IC	59	0	59
Annual IC Time Burden (Hours)	9,213	-5,301	14,514
Annual IC Cost Burden (Dollars)	0	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.