Information Collection

42 CFR 485.916(d) Treatment team, active treatment plan, and coordination of services

IC 210875 under ICR 201707-0938-012 · OMB 0938-1245.

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Information Collection (IC) Details

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IC Title:	42 CFR 485.916(d) Treatment team, active treatment plan, and coordination of services	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 485.916(d)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 52	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5,202	-17,498	22,700
Annual IC Time Burden (Hours)	433	-1,459	1,892
Annual IC Cost Burden (Dollars)	0	0	0

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