Information Collection

CSC Staff Interview

IC 227218 under ICR 201706-0930-001 · OMB 0930-0376.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CSC Staff Intervie CSC Staff Interview	Form and Instruction
CSC Staff Intervie CSC Staff Interview Attachment 3 - Coordinated Specialty Care (CSC) Program Staff Interview 2-22-17.docx	Form and Instruction

IC Title:

CSC Staff Interview

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CSC Staff Interview	CSC Staff Interview	Attachment 3 - Coordinated Specialty Care (CSC) Program Staff Interview 2-22-17.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 192

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	192	192
Annual IC Time Burden (Hours)	384	384
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.