Information Collection

Site Vistis

IC 218531 under ICR 201510-0930-001 · OMB 0930-0353.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Site Visit Materia Site Vistis	Form and Instruction
Site Visit Materia Site Visit Materials Attachment 3_Site Visit Materials _to_SAMHSA 10.14.15.docx	Form and Instruction

IC Title:

Site Vistis

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	Site Visit Materials	Site Visit Materials	Attachment 3_Site Visit Materials _to_SAMHSA 10.14.15.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

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
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	160	160
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.