Information Collection

Mental Health Service Professional Demonstration Grant Program Application

IC 254959 under ICR 202210-1810-001 · OMB 1810-0772.

Documents and Forms

Document Name Document Type
Mental Health Service Professional Demonstration Grant Program Application Form
1810-new_84.184X MHSP Application Package.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Mental Health Service Professional Demonstration Grant Program Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection 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 %

	Approved	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

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.