Client-Level

Transformation Accountability (TRAC) Reporting System

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0285 can be found here:

Documents and Forms

Document Name Document Type
Form Adult Tool with Re Client-Level Form and Instruction
Adult Tool with Re AdultTool with Recovery Measures CMHS SVCS AdultTool with Recovery Measures 9-9-16 FINAL.docx Form and Instruction
Child Combined Too Child Combined Tool SVCS_ChildCombinedTool_11.19.13.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Client-Level	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	Adult Tool with Recovery Measures	AdultTool with Recovery Measures	CMHS SVCS AdultTool with Recovery Measures 9-9-16 FINAL.docx		Yes	Yes	Fillable Fileable
Form and Instruction	Child Combined Tool	Child Combined Tool	SVCS_ChildCombinedTool_11.19.13.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 144,954	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	144,954	46,806	98,148
Annual IC Time Burden (Hours)	70,240	36,281	33,959
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.