CMHS NOMS Data Collection Tool

Mental Health Client/Consumer Outcome Measures and Infrastructure, Prevention and Promotion Indicators

Documents and Forms

Document Name Document Type
Form Client Level Measu CMHS NOMS Data Collection Tool Form and Instruction
Client Level Measu Client Level Measures A_CMHS Client Level Measures Data Collection.docx Form and Instruction
Client Level Measu Client Level Measures A_CMHS Client Level Measures Data Collection.docx Form and Instruction

Information Collection (IC) Details

IC Title:	CMHS NOMS Data Collection Tool	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

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	Client Level Measures	Client Level Measures	A_CMHS Client Level Measures Data Collection.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: CMHS NOMS Data Collection Tool	FR Citation: 75 FR 28264

Number of Respondents: 393,060	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 Agency Discretion	Previously Approved
Annual Number of Responses for this IC	448,088	294,029	154,059
Annual IC Time Burden (Hours)	75,178	6,505	68,673
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.