Application

Community MH Services BG and SAPT BG Application Guidance and Instructions FY 2016-2017

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0168 can be found here:

Documents and Forms

Document Name Document Type
Form BG Application Application Form and Instruction
BG Application BG Application BG Application FY16-17.pdf Form and Instruction
FY16-17 SABG Reporting.pdf SABG Reporting IC Document
FY16 17 MHBG Reporting.pdf MHBG Reporting IC Document
FY 16-17 SABG-funding-agreements.pdf SABG Funding-agreements IC Document
FY 16-17 MHBG-funding-agreements.pdf MHBG Funding-agreements IC Document

Information Collection (IC) Details

IC Title:	Application	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	BG Application	BG Application	BG Application FY16-17.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 119	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	119	119
Annual IC Time Burden (Hours)	37,429	37,429
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SABG Reporting	FY16-17 SABG Reporting.pdf	06/12/2015
MHBG Reporting	FY16 17 MHBG Reporting.pdf	06/12/2015
SABG Funding-agreements	FY 16-17 SABG-funding-agreements.pdf	06/12/2015
MHBG Funding-agreements	FY 16-17 MHBG-funding-agreements.pdf	06/12/2015

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