Information Collection

SAMHSA Application for Peer Grant Reviewers

IC 7670 under ICR 201608-0930-004 · OMB 0930-0255.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0255 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Peer Review\RCI Fo SAMHSA Application for Peer Grant Reviewers	Form and Instruction
Peer Review\RCI Fo Peer Review\RCI Form RCI Form_2016.docx	Form and Instruction
Public Burden Statement.doc Public Burden Statement	IC Document

IC Title:

SAMHSA Application for Peer Grant Reviewers

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	Peer Review\RCI Form	Peer Review\RCI Form	RCI Form_2016.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	750	750
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Public Burden Statement	Public Burden Statement.doc	08/17/2016

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