Information Collection

RCORP – Child and Adolescent Behavioral Health (NEW)

IC 269425 under ICR 202407-0906-002 · OMB 0906-0044.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0044 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 6 RCORP – Child and Adolescent Behavioral Health (NEW)	Form and Instruction
6 RCORP CABH DRAFT PIMS Measures FINAL 07092024 RCORP CABH DRAFT PIMS Measures FINAL 07092024.docx	Form and Instruction
6 RCORP CABH DRAFT PIMS Measures FINAL 07092024 RCORP CABH DRAFT PIMS Measures FINAL 07092024.docx	Form and Instruction

IC Title:

RCORP â Child and Adolescent Behavioral Health (NEW)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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	6	RCORP CABH DRAFT PIMS Measures FINAL 07092024	RCORP CABH DRAFT PIMS Measures FINAL 07092024.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 9

Number of Respondents for Small Entity: 9

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	18	18
Annual IC Time Burden (Hours)	9	9
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.