FY 2018 Expanding Access to Quality SUD-MH/IBHS Progress Reporting

The Health Center Program Application Forms

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0285 can be found here:

Documents and Forms

Document Name Document Type
Form 28 FY 2018 Expanding Access to Quality SUD-MH/IBHS Progress Reporting Form and Instruction
28 FY2018 Expanding Access to Quality SUD-MH IBHS Progress FY2018 Expanding Access to Quality SUD-MH IBHS Progress Reporting.docx Form and Instruction

Information Collection (IC) Details

IC Title:	FY 2018 Expanding Access to Quality SUD-MH/IBHS Progress Reporting	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Form and Instruction	28	FY2018 Expanding Access to Quality SUD-MH IBHS Progress Reporting.docx	FY2018 Expanding Access to Quality SUD-MH IBHS Progress Reporting.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,375	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,125	2,925	1,200
Annual IC Time Burden (Hours)	4,125	2,925	1,200
Annual IC Cost Burden (Dollars)	0	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.