Information Collection

Individual/Family Crisis Counseling Servies Encounter Log

IC 7686 under ICR 201507-0930-001 · OMB 0930-0270.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0270 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Individual_Family_ Individual/Family Crisis Counseling Servies Encounter Log	Form and Instruction
Individual_Family_ Individual_Family_Encounter_Form 3_20_15_Attachment A_Individual_Family_Encounter_Form.docx	Form and Instruction

IC Title:

Individual/Family Crisis Counseling Servies Encounter Log

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Individual_Family_Encounter_Form	Individual_Family_Encounter_Form	3_20_15_Attachment A_Individual_Family_Encounter_Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

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	39,200	39,200
Annual IC Time Burden (Hours)	5,096	5,096
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.