OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Program Staff Questionnaires (Form M-11A-K) - Recordkeeping

IC 245605 under ICR 202403-0970-014 · OMB 0970-0564.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form Form M-11A
Program Staff Questionnaires (Form M-11A-K) - Recordkeeping		 Form and Instruction
Form Form M-11A
Program Director Questionnaire Program Staff Questionnaires (Form M-11A-K) - Recordkeeping		 Form and Instruction
Form Form M-11B
LTFC Program Director Questionnaire Program Staff Questionnaires (Form M-11A-K) - Recordkeeping		 Form and Instruction
Form Form M-11C
Clinician Questionnaire Program Staff Questionnaires (Form M-11A-K) - Recordkeeping		 Form and Instruction
Form Form M-11D
LTFC Clinician Questionnaire Program Staff Questionnaires (Form M-11A-K) - Recordkeeping		 Form and Instruction
Form Form M-11E
Case Manager Questionnaire Program Staff Questionnaires (Form M-11A-K) - Recordkeeping		 Form and Instruction
Form Form M-11F
LTFC Case Manager Questionnaire Program Staff Questionnaires (Form M-11A-K) - Recordkeeping		 Form and Instruction
Form Form M-11G
Education Staff Questionnaire Program Staff Questionnaires (Form M-11A-K) - Recordkeeping		 Form and Instruction
Form Form M-11H
LTFC Educational Staff Questionnaire Program Staff Questionnaires (Form M-11A-K) - Recordkeeping		 Form and Instruction
Form Form M-11I
Medical Coordinator Questionnaire Program Staff Questionnaires (Form M-11A-K) - Recordkeeping		 Form and Instruction
Form Form M-11J
Youth Care Worker Questionnaire Program Staff Questionnaires (Form M-11A-K) - Recordkeeping		 Form and Instruction
Form Form M-11K
PSA Compliance Manager Questionnaire Program Staff Questionnaires (Form M-11A-K) - Recordkeeping		 Form and Instruction
Form M-11A Program Director Questionnaire
Program Director Questionnaire (Form M-11A).docx 		Form and Instruction
Form M-11A Program Director Questionnaire
Program Director Questionnaire (Form M-11A).docx 		Form and Instruction
Form M-11B LTFC Program Director Questionnaire
LTFC Program Director Questionnaire (Form M-11B).docx 		Form and Instruction
Form M-11B LTFC Program Director Questionnaire
LTFC Program Director Questionnaire (Form M-11B).docx 		Form and Instruction
Form M-11C Clinician Questionnaire
Clinician Questionnaire (Form M-11C).docx 		Form and Instruction
Form M-11C Clinician Questionnaire
Clinician Questionnaire (Form M-11C).docx 		Form and Instruction
Form M-11D LTFC Clinician Questionnaire
LTFC Clinician Questionnaire (Form M-11D).docx 		Form and Instruction
Form M-11D LTFC Clinician Questionnaire
LTFC Clinician Questionnaire (Form M-11D).docx 		Form and Instruction
Form M-11E Case Manager Questionnaire
Case Manager Questionnaire (Form M-11E).docx 		Form and Instruction
Form M-11E Case Manager Questionnaire
Case Manager Questionnaire (Form M-11E).docx 		Form and Instruction
Form M-11F LTFC Case Manager Questionnaire
LTFC Case Manager Questionnaire (Form M-11F).docx 		Form and Instruction
Form M-11F LTFC Case Manager Questionnaire
LTFC Case Manager Questionnaire (Form M-11F).docx 		Form and Instruction
Form M-11G Education Staff Questionnaire
Education Staff Questionnaire (Form M-11G).docx 		Form and Instruction
Form M-11G Education Staff Questionnaire
Education Staff Questionnaire (Form M-11G).docx 		Form and Instruction
Form M-11H LTFC Educational Staff Questionnaire
LTFC Educational Staff Questionnaire (Form M-11H).docx 		Form and Instruction
Form M-11H LTFC Educational Staff Questionnaire
LTFC Educational Staff Questionnaire (Form M-11H).docx 		Form and Instruction
Form M-11I Medical Coordinator Questionnaire
Medical Coordinator Questionnaire (Form M-11I).docx 		Form and Instruction
Form M-11I Medical Coordinator Questionnaire
Medical Coordinator Questionnaire (Form M-11I).docx 		Form and Instruction
Form M-11J Youth Care Worker Questionnaire
Youth Care Worker Questionnaire (Form M-11J).docx 		Form and Instruction
Form M-11J Youth Care Worker Questionnaire
Youth Care Worker Questionnaire (Form M-11J).docx 		Form and Instruction
Form M-11K PSA Compliance Manager Questionnaire
PSA Compliance Manager Questionnaire (Form M-11K).docx 		Form and Instruction
Form M-11K PSA Compliance Manager Questionnaire
PSA Compliance Manager Questionnaire (Form M-11K).docx 		Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 Form M-11A Yes Yes Fillable Fileable
Form and Instruction Form M-11B Yes Yes Fillable Fileable
Form and Instruction Form M-11C Yes Yes Fillable Fileable
Form and Instruction Form M-11D Yes Yes Fillable Fileable
Form and Instruction Form M-11E Yes Yes Fillable Fileable
Form and Instruction Form M-11F Yes Yes Fillable Fileable
Form and Instruction Form M-11G Yes Yes Fillable Fileable
Form and Instruction Form M-11H Yes Yes Fillable Fileable
Form and Instruction Form M-11I Yes Yes Fillable Fileable
Form and Instruction Form M-11J Yes Yes Fillable Fileable
Form and Instruction Form M-11K Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 216 0 0 0 0 216
Annual IC Time Burden (Hours) 216 0 0 0 0 216
Annual IC Cost Burden (Dollars) 0 0 0 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.
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