Information Collection

Mental Health Service Professional Demonstration Grant Program Application

IC 254959 under ICR 202208-1810-001 · OMB 1810-0772.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1810-0772 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Mental Health Service Professional Demonstration Grant Program Application	Form
1810-new_MHSP Application Package_7-29.docx	Form
1810-new_84.184X MHSP Application Package.docx	Form

IC Title:

Mental Health Service Professional Demonstration Grant Program Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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	N/A	N/A	1810-new_84.184X MHSP Application Package.docx		Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

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
	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	20,000	20,000
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.