Application

Community MH Services BG and SAPT BG Application Guidance and Instructions FY 2018-2019

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0168 can be found here:

Documents and Forms

Document Name Document Type
Form BG\FY 2018-2019 Bl Application Form and Instruction
BG\FY 2018-2019 Bl BG\FY 2018-2019 Block Grant Application FY 2018-2019 Block Grant Application and Plan.pdf Form and Instruction
FY18-19MHBG-funding-agreements.pdf BG\FY18-19 MHBG-funding-agreements IC Document
FY18-19SABG-funding-agreements.pdf BG\FY18-19 SABG-funding-agreements IC Document
MHBG Report.pdf BG\MHBG Report IC Document
SABG Report.pdf BG\SABG Report IC Document
Block Grant comments. docx.docx Comments IC Document

Information Collection (IC) Details

IC Title:	Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	BG\FY 2018-2019 Block Grant Application	BG\FY 2018-2019 Block Grant Application	FY 2018-2019 Block Grant Application and Plan.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 119	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	119	0	119
Annual IC Time Burden (Hours)	33,374	-4,055	37,429
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
BG\FY18-19 MHBG-funding-agreements	FY18-19MHBG-funding-agreements.pdf	06/02/2017
BG\FY18-19 SABG-funding-agreements	FY18-19SABG-funding-agreements.pdf	06/02/2017
BG\MHBG Report	MHBG Report.pdf	06/02/2017
BG\SABG Report	SABG Report.pdf	06/02/2017
Comments	Block Grant comments. docx.docx	06/02/2017

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