Surveys to Inform Service Delivery Improvement of Teen Intervene Curriculum with Mental Health Providers and Adolescent Clients

Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0379 can be found here:

Documents and Forms

Document Name Document Type
AttachmentA.TeenproviderEvaluation (002).pdf Other-survey
AttachmentB.TI.Teen.Evaluation (002).pdf Other-survey
LakesRequestFASTTrackMemoy3 29 18.pdf memo IC Document

Information Collection (IC) Details

IC Title:	Surveys to Inform Service Delivery Improvement of Teen Intervene Curriculum with Mental Health Providers and Adolescent Clients	Agency IC Tracking Number:

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-survey			AttachmentA.TeenproviderEvaluation (002).pdf		Yes	Yes	Fillable Fileable
Other-survey			AttachmentB.TI.Teen.Evaluation (002).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 57	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	57	57
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
memo	LakesRequestFASTTrackMemoy3 29 18.pdf	03/29/2018

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