Mental Health Assessment Form - Reporting Time

Mental Health Assessment Form, Public Health Investigation Form: Active TB, and Public Health Investigation Form: Non-TB Illness

OMB: 0970-0509

IC ID: 229902

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Mental Health Assessment Form - Reporting Time
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 Mental Health Assessment Form ORR Mental Health Assessment Form_0970-0509_Clean.docx Yes Yes Fillable Printable

Community and Social Services Social Services

ORR Division of Children's Services Records  81 FR 46682

500 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 3,400 0 0 0 0 3,400
Annual IC Time Burden (Hours) 612 0 0 0 0 612
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment B - Mental Health Assessment Form Instructional Letter for Mental Health Providers Attachment B_Mental Health Assessment Form Instructional Letter for Mental Health Providers.docx 08/03/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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