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MH-CLD SHR Data
Treatment Episode Data Set (TEDS)
OMB: 0930-0335
IC ID: 219073
OMB.report
HHS/SAMHSA
OMB 0930-0335
ICR 202111-0930-001
IC 219073
( )
Documents and Forms
Document Name
Document Type
IC4.docx
Other-
IC4.docx
Other-
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
MH-CLD SHR Data
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-
IC4.docx
Yes
Yes
Printable Only
Federal Enterprise Architecture Business Reference Module
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 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
30
0
0
0
0
30
Annual IC Time Burden (Hours)
150
0
0
0
0
150
Annual IC Cost Burden (Dollars)
0
0
0
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.
