PMHCA Practice Level Survey

Evaluation of the Maternal and Child Health Bureau Pediatric Mental Health Care Access Program and the Screening and Treatment for Maternal Depression and Related Behavioral Disorders Program

OMB: 0906-0074

IC ID: 256694

Information Collection (IC) Details

View Information Collection (IC)

PMHCA Practice Level Survey
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 2 Practice Level Survey Attachment B2 - Practice-Level Survey2 - Copy.docx Yes Yes Fillable Fileable

Health Health Care Services

 

2,950 2,950
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   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 2,950 0 0 0 0 2,950
Annual IC Time Burden (Hours) 2,213 0 0 0 0 2,213
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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