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Block Grant Application
Community MH Services BG and SAPT BG Application Guidance and Instructions FY 2024-2025
OMB: 0930-0168
IC ID: 7545
OMB.report
HHS/SAMHSA
OMB 0930-0168
ICR 202304-0930-002
IC 7545
( )
Documents and Forms
Document Name
Document Type
Form SAMHSA_BG_Applicat
Block Grant Application
Form and Instruction
SAMHSA_BG_Applicat SAMHSA_BG_Application_2024-25
SAMHSA_BG_Application_2024-25_clean_4.7.2023.docx
Form and Instruction
SAMHSA_BG_Applicat SAMHSA_BG_Application_2024-25
SAMHSA_BG_Application_2024-25_clean_4.7.2023.docx
Form and Instruction
2024 to 2025 SABG Report Final 3.26.23 v3 OMB Clean.docx
2024 to 2025 SABG Report
IC Document
2024 to 2025 SABG Report Final 3.26.23 v3 OMB Clean.docx
2024 to 2025 SABG Report
IC Document
SAMHSA_BG_Application_2024-25_clean_4.7.2023.docx
2024-2025 MHBG Report
IC Document
SAMHSA_BG_Application_2024-25_clean_4.7.2023.docx
2024-2025 MHBG Report
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Block Grant 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 and Instruction
SAMHSA_BG_Application_2024-25
SAMHSA_BG_Application_2024-25
SAMHSA_BG_Application_2024-25_clean_4.7.2023.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
119
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
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
119
0
0
0
0
119
Annual IC Time Burden (Hours)
24,613
0
-8,880
0
0
33,493
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
2024 to 2025 SABG Report
2024 to 2025 SABG Report Final 3.26.23 v3 OMB Clean.docx
05/02/2023
2024-2025 MHBG Report
SAMHSA_BG_Application_2024-25_clean_4.7.2023.docx
05/02/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.