Information Collection

Primary Care Mental Health Integration (PCMHI) Services - Virtual Care Survey

IC 249682 under ICR 202007-2900-004 · OMB 2900-0770.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0770 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
PCMHI Virtual Care Survey (Puget Sound)_updated Oct 2021.docx	Other-Survey
Generic Supporting Statement_PCMHI Virtual Care Survey_2900-0770_updated Oct 2021.docx Generic Supporting Statement - PCMHI Virtual Care Survey - 2900-0770 - 2021	IC Document

IC Title:

Primary Care Mental Health Integration (PCMHI) Services - Virtual Care Survey

Agency IC Tracking Number:

VHA-2900-0770

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey					Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 125

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	125	125
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Supporting Statement - PCMHI Virtual Care Survey - 2900-0770 - 2021		10/28/2021

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

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