Information Collection

State and Territory Cooperative Agreements

IC 260136 under ICR 202312-0930-001 · OMB 0930-0394.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0394 can be found here:

2025-09-12 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form State/Territory: M State and Territory Cooperative Agreements	Form and Instruction
State/Territory: M State/Territory: Monthly Key Metrics State and Territory Instrument 1 _ Monthly Key Metrics 4.5.23.docx	Form and Instruction
State/Territory: M State/Territory: Monthly Key Metrics State and Territory Instrument 1 _ Monthly Key Metrics 4.5.23.docx	Form and Instruction
State/Territory: C State/Territory: Chat and Text Report State and Territory Instrument 5 _ Chat & Text Report 4.5.23.docx	Form and Instruction
State/Territory: C State/Territory: Chat and Text Report State and Territory Instrument 5 _ Chat & Text Report 4.5.23.docx	Form and Instruction
State/Territory: C State/Territory: Communications Plan State and Territory Instrument 6 _ Comm Plan 4.5.23.docx	Form and Instruction
State/Territory: C State/Territory: Communications Plan State and Territory Instrument 6 _ Comm Plan 4.5.23.docx	Form and Instruction
State/Territory: M State/Territory: Mobile Crisis and 988-911 reports State and Territory Instrument 8 _ Mobile Crisis - 988 Report 4.5.23.docx	Form and Instruction
State/Territory: M State/Territory: Mobile Crisis and 988-911 reports State and Territory Instrument 8 _ Mobile Crisis - 988 Report 4.5.23.docx	Form and Instruction
State/Territory: C State/Territory: Cohort 2: Monthly Meeting Agenda SAMHSA 988 State Territory Grant (Cohort 2) - Monthly Call Agenda (FINAL).docx	Form and Instruction
State/Territory: C State/Territory: Cohort 2: Monthly Meeting Agenda SAMHSA 988 State Territory Grant (Cohort 2) - Monthly Call Agenda (FINAL).docx	Form and Instruction
State/Territory: C State/Territory: Cohort 2 Quarterly Report SAMHSA 988 State Territory Grant (Cohort 2) - Quarterly Report Template (FINAL).docx	Form and Instruction
State/Territory: C State/Territory: Cohort 2 Quarterly Report SAMHSA 988 State Territory Grant (Cohort 2) - Quarterly Report Template (FINAL).docx	Form and Instruction
State/Territory: C State/Territory: Cohort 2 Required Data SAMHSA 988 State Territory Grant (Cohort 2) - required data-(FINAL).docx	Form and Instruction
State/Territory: C State/Territory: Cohort 2 Required Data SAMHSA 988 State Territory Grant (Cohort 2) - required data-(FINAL).docx	Form and Instruction
State/Territory QI State/Territory QI Plan 0930-0394 State and Territory Instrument 3 _ QI Plan (FINAL).docx	Form and Instruction
State/Territory QI State/Territory QI Plan 0930-0394 State and Territory Instrument 3 _ QI Plan (FINAL).docx	Form and Instruction
State/Territory: C State/Territory: Cohort 1 Quarterly Report 0930-0394 State and Territory Instrument 2 (COHORT 1) _ Qtrly Report (FINAL).docx	Form and Instruction
State/Territory: C State/Territory: Cohort 1 Quarterly Report 0930-0394 State and Territory Instrument 2 (COHORT 1) _ Qtrly Report (FINAL).docx	Form and Instruction
State/Territory: M State/Territory: Monthly Call Agenda 0930-0394 State and Territory Instrument 4 _ Monthly Call Agenda 4 4.5.23.docx	Form and Instruction
State/Territory: M State/Territory: Monthly Call Agenda 0930-0394 State and Territory Instrument 4 _ Monthly Call Agenda 4 4.5.23.docx	Form and Instruction
State/Territory: S State/Territory: Sustainability Plan 0930-0394 State and Territory Instrument 7 _ Sustainability Plan 4.5.23.docx	Form and Instruction
State/Territory: S State/Territory: Sustainability Plan 0930-0394 State and Territory Instrument 7 _ Sustainability Plan 4.5.23.docx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

State and Territory Cooperative Agreements

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	State/Territory: Monthly Key Metrics	State/Territory: Monthly Key Metrics	State and Territory Instrument 1 _ Monthly Key Metrics 4.5.23.docx	Yes	Yes	Fillable Fileable
Form and Instruction	State/Territory: Chat and Text Report	State/Territory: Chat and Text Report	State and Territory Instrument 5 _ Chat & Text Report 4.5.23.docx	Yes	Yes	Fillable Fileable
Form and Instruction	State/Territory: Communications Plan	State/Territory: Communications Plan	State and Territory Instrument 6 _ Comm Plan 4.5.23.docx	Yes	Yes	Fillable Fileable
Form and Instruction	State/Territory: Mobile Crisis and 988-911 reports	State/Territory: Mobile Crisis and 988-911 reports	State and Territory Instrument 8 _ Mobile Crisis - 988 Report 4.5.23.docx	Yes	Yes	Fillable Fileable
Form and Instruction	State/Territory: Cohort 2 Monthly Meeting Agenda	State/Territory: Cohort 2: Monthly Meeting Agenda	SAMHSA 988 State Territory Grant (Cohort 2) - Monthly Call Agenda (FINAL).docx	Yes	Yes	Fillable Fileable
Form and Instruction	State/Territory: Cohort 2 Quarterly Report	State/Territory: Cohort 2 Quarterly Report	SAMHSA 988 State Territory Grant (Cohort 2) - Quarterly Report Template (FINAL).docx	Yes	Yes	Fillable Fileable
Form and Instruction	State/Territory: Cohort 2 Required Data	State/Territory: Cohort 2 Required Data	SAMHSA 988 State Territory Grant (Cohort 2) - required data-(FINAL).docx	Yes	Yes	Fillable Fileable
Form and Instruction	State/Territory QI Plan	State/Territory QI Plan	0930-0394 State and Territory Instrument 3 _ QI Plan (FINAL).docx	Yes	Yes	Fillable Fileable
Form and Instruction	State/Territory: Cohort 1 Quarterly Report	State/Territory: Cohort 1 Quarterly Report	0930-0394 State and Territory Instrument 2 (COHORT 1) _ Qtrly Report (FINAL).docx	Yes	Yes	Fillable Fileable
Form and Instruction	State/Territory: Monthly Call Agenda	State/Territory: Monthly Call Agenda	0930-0394 State and Territory Instrument 4 _ Monthly Call Agenda 4 4.5.23.docx	Yes	Yes	Fillable Fileable
Form and Instruction	State/Territory: Sustainability Plan	State/Territory: Sustainability Plan	0930-0394 State and Territory Instrument 7 _ Sustainability Plan 4.5.23.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Privacy Act of 1974 (Title 5 United States Code [U.S.C.] 552a)

FR Citation: 75 FR 28264

Number of Respondents: 594

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	Previously Approved
Annual Number of Responses for this IC	2,592	864	1,728
Annual IC Time Burden (Hours)	3,348	1,080	2,268
Annual IC Cost Burden (Dollars)	0	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.