Information Collection

State Official Interviews

IC 255614 under ICR 202208-0990-007 · OMB 0990-0485.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A. CCBHC State Official Interview Protocol_Year 2.docx	Other-Interview Protocol
Attachment A. CCBHC State Official Interview Protocol_Year 2.docx	Other-Interview Protocol
Attachment B. CCBHC State Official Interview Protocol_Year 3.docx CCBHC State Official Interview Protocol Year 3	IC Document
Attachment B. CCBHC State Official Interview Protocol_Year 3.docx CCBHC State Official Interview Protocol Year 3	IC Document
Attachment C. CCHBC State Official Interview Protocol_Year 4.docx CCBHC State Official Interview Protocol Year 4	IC Document
Attachment C. CCHBC State Official Interview Protocol_Year 4.docx CCBHC State Official Interview Protocol Year 4	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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-Interview Protocol			Attachment A. CCBHC State Official Interview Protocol_Year 2.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 27

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	27	27
Annual IC Time Burden (Hours)	27	27
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CCBHC State Official Interview Protocol Year 3	Attachment B. CCBHC State Official Interview Protocol_Year 3.docx	08/25/2022
CCBHC State Official Interview Protocol Year 4	Attachment C. CCHBC State Official Interview Protocol_Year 4.docx	08/25/2022

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