Information Collection

2022 PMHCA HP Survey

IC 258756 under ICR 202302-0906-003 · OMB 0906-0074.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1A 2022 PMHCA HP Survey	Form and Instruction
Form 1A 2022 PMHCA HP Survey	Form and Instruction
1A 2022 PMHCA HP Survey Attachment B1 - HP Survey1 - Copy.docx	Form and Instruction
1A 2022 PMHCA HP Survey Attachment B1 - HP Survey1 - Copy.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Form and Instruction	1A	2022 PMHCA HP Survey	Attachment B1 - HP Survey1 - 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: 1,673

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
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,019	5,019
Annual IC Time Burden (Hours)	1,255	1,255
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.