Information Collection

State consumer/family representative-telephone interview

IC 227609 under ICR 201707-0990-001 · OMB 0990-0461.

Documents and Forms

Document Name Document Type
Attachment K CCBHC Evaluation End Consumer-Family Interview_OMB.docx Other-interview

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State consumer/family representative-telephone interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-interview			Attachment K CCBHC Evaluation End Consumer-Family Interview_OMB.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	16	16
Annual IC Time Burden (Hours)	16	16
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.