Information Collection

OMH Grantee

IC 10408 under ICR 201811-0990-002 · OMB 0990-0275.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0275 can be found here:

Documents and Forms

Document Name Document Type
Instrument_homepage-upd.png Other-form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	OMH Grantee	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-form			Instrument_homepage-upd.png		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-400	400
Annual IC Time Burden (Hours)	-600	600
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.