Form North Carolina Fam North Carolina Fam North Carolina Family Assessment Form

OMB No. 0930-0330
Expiration Date: xx/xx/xx

Attachment B
North Carolina Family Assessment Scale (NCFAS G+R)

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a currently valid OMB control
number. The OMB control number for this project is 0930-0330. Public reporting burden for
this collection of information is estimated to average 45 minutes per respondent, per year,
including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke
Cherry Road, Room 2-1057, Rockville, Maryland, 20857.