Information Collection

MH-CLD BCI Data

IC 219072 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form TEDS_MH and MH-CLD MH-CLD BCI 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 A4 MHBG URS Tables.xlsx MHBG URS Tables	IC Document

IC Title:

MH-CLD BCI Data

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	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: 30

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	30	30
Annual IC Time Burden (Hours)	900	900
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
MHBG URS Tables	Attachment A4 MHBG URS Tables.xlsx	11/24/2015

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