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Client Focus Group
Evaluation of Programs to Provide Services to Persons Who Are Homeless with Mental and /or Substance Use Disorders
OMB: 0930-0339
IC ID: 208310
OMB.report
HHS/SAMHSA
OMB 0930-0339
ICR 201701-0930-003
IC 208310
( )
Documents and Forms
Document Name
Document Type
Form SV Guide_Cost Ques
Client Focus Group
Form and Instruction
SV Guide_Cost Ques SV Guide_Cost Questionnaire
Attachment 2_SV Guide_Cost Questionnaire.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Client Focus Group
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
SV Guide_Cost Questionnaire
SV Guide_Cost Questionnaire
Attachment 2_SV Guide_Cost Questionnaire.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
450
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 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
450
0
150
0
0
300
Annual IC Time Burden (Hours)
675
0
225
0
0
450
Annual IC Cost Burden (Dollars)
0
0
0
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.