Information Collection

Client-Level

IC 46632 under ICR 201802-0930-002 · OMB 0930-0285.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0285 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Section H Client-Level	Form and Instruction
Section H Section H Attachment D - CMHS Client-Level Services Section H Tool for PBHCI 2.13.18.docx	Form and Instruction
Adult Tool Adult Tool CMHS GPRA TOOL ADULTS 2 22 2019.docx	Form and Instruction
Child Tool Child Tool CMHS GPRA TOOL CHILD ADOLESCENT 2 22 2019.docx	Form and Instruction

IC Title:

Client-Level

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Section H	Section H	Attachment D - CMHS Client-Level Services Section H Tool for PBHCI 2.13.18.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Child Tool	Child Tool	CMHS GPRA TOOL CHILD ADOLESCENT 2 22 2019.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Adult Tool	Adult Tool	CMHS GPRA TOOL ADULTS 2 22 2019.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 58,802

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	Previously Approved
Annual Number of Responses for this IC	190,636	45,682	144,954
Annual IC Time Burden (Hours)	96,312	26,072	70,240
Annual IC Cost Burden (Dollars)	0	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.