Mental Health Treatment Summary Form

Individual Specific Medical Evaluation Forms (15)

OMB: 0420-0550

IC ID: 201707

Documents and Forms
Information Collection (IC) Details

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Mental Health Treatment Summary Form
 
No Removed
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction TG-510-3 Mental Health Treatment Summary Mental_Health_Treatment Summary.pdf Yes Yes Fillable Printable

International Affairs and Commerce International Development and Humanitarian Aid

Volunteer Applicant and Service Records  70 FR 1

300 0
   
Individuals or Households
 
   99 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 0 0 -300 0 0 300
Annual IC Time Burden (Hours) 0 0 -825 0 0 825
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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