Fidelity Interview

Mental Health Block Grant Ten Percent Set Aside Evaluation

OMB: 0930-0376

IC ID: 227221

Documents and Forms
Information Collection (IC) Details

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Fidelity Interview
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Fidelity Interview Fidelity Interview Attachment 6 - Fidelity Interview 2-22-17.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

64 0
   
State, Local, and Tribal Governments
 
   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 256 0 256 0 0 0
Annual IC Time Burden (Hours) 1,024 0 1,024 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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