Information Collection

2021 PMHCA Program Implementation Survey

IC 256695 under ICR 202302-0906-003 · OMB 0906-0074.

Documents and Forms

Document Name Document Type
Attachment B3 - Program Implementation Survey PMHCA3 - Copy.docx Other-
Attachment B3 - Program Implementation Survey PMHCA3 - Copy.docx Other-

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	2021 PMHCA Program Implementation Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-			Attachment B3 - Program Implementation Survey PMHCA3 - 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: 24	Number of Respondents for Small Entity: 24

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	24	24
Annual IC Time Burden (Hours)	24	24
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.