Information Collection

MH-CLD BCI Data

IC 219072 under ICR 202111-0930-001 · OMB 0930-0335.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0335 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form MHBG Tables 2021 MH-CLD BCI Data	Form and Instruction
MHBG Tables 2021 MHBG Tables 2021 Attachment A4- 2021 TEDS- MHBG Application URS Tables.xls	Form and Instruction
MHBG Tables 2021 MHBG Tables 2021 Attachment A4- 2021 TEDS- MHBG Application URS Tables.xls	Form and Instruction

IC Title:

MH-CLD BCI Data

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	MHBG Tables 2021	MHBG Tables 2021	Attachment A4- 2021 TEDS- MHBG Application URS Tables.xls		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

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	Previously Approved
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	900	900
Annual IC Cost Burden (Dollars)	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.