Information Collection

CMHS Client -Level Data

IC 213379 under ICR 201501-0930-004 · OMB 0930-0346.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CoC Questions CMHS Client -Level Data	Form and Instruction
PBHCI SECTION H PBHCI SECTION H Attachment 2 PBHCI SECTION H FINAL CDP.pdf	Form and Instruction
CoC Questions CoC Questions Attachment 8 CoC Questions Final 12 19 2014 .docx	Form and Instruction
CMHS Instrument CMHS Instrument Attachment 1 Final CMHS Instrument 1.12.15.docx	Form and Instruction
Attachment 10 CMHS CSAT Manual 11 19.docx CMHS CSAT Manual	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	CoC Questions	CoC Questions	Attachment 8 CoC Questions Final 12 19 2014 .docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMHS Instrument	CMHS Instrument	Attachment 1 Final CMHS Instrument 1.12.15.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	Previously Approved
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.