Information Collection

2018/2019 PMHCA/2018 MDRBD Care Coordinator SSI

IC 256686 under ICR 202302-0906-003 · OMB 0906-0074.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment B12 - MDRBD Care Coordinator SSI - Copy.docx	Other-Semi Structured Interview
Attachment B12 - MDRBD Care Coordinator SSI - Copy.docx	Other-Semi Structured Interview

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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-Semi Structured Interview			Attachment B12 - MDRBD Care Coordinator SSI - Copy.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 28

Number of Respondents for Small Entity: 28

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	28	28
Annual IC Time Burden (Hours)	14	14
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.