OMB Approval # 0990-0XXX
Expiration Date: XX/XX/2018
Health Care Linkages (Linkages to Health Care Services)
In the reporting period, how many referrals were made by program staff to off-site providers or SBHCs for ANY of the following health services: Reproductive Health Care; Mental Health Services; Primary Health Care; Educational Services; Vocational Education/Workforce Development; Intimate Partner Violence Prevention; Healthy Relationships Training. (Collect # of each)
The performance measures reported to the agency will be obtained by summing the responses to the questions across grantee types and tiers.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0XXX. The time required to complete this information collection is estimated to average 0.25 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Tara Rice |
| File Modified | 0000-00-00 |
| File Created | 2021-01-22 |