Information Collection

TEDS Admission Data

IC 204348 under ICR 201511-0930-002 · OMB 0930-0335.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0335 can be found here:

Documents and Forms

Document Name Document Type
Form TEDS_MH and MH-CLD TEDS Admission Data Form and Instruction
TEDS_MH and MH-CLD TEDS_MH and MH-CLD Data Elements Attachment A1_TEDS_MH and MH-CLD Data Elements.xlsx Form and Instruction
Attachment A3 SABG application tables 16-22.pdf SABG Application Tables IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	TEDS Admission Data	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

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	TEDS_MH and MH-CLD Data Elements	TEDS_MH and MH-CLD Data Elements	Attachment A1_TEDS_MH and MH-CLD Data Elements.xlsx		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 52	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	208	-208	416
Annual IC Time Burden (Hours)	1,300	-1,716	3,016
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SABG Application Tables	Attachment A3 SABG application tables 16-22.pdf	11/24/2015

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