Information Collection

Psychotropic Medication Informed Consent (Form MMH-1)

IC 272295 under ICR 202411-0970-005 · OMB 0970-0641.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0641 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form MMH-1 Psychotropic Medication Informed Consent (Form MMH-1)	Form and Instruction
Form MMH-1 Psychotropic Medication Informed Consent Psychotropic Medication Informed Consent (Form MMH-1)	Form and Instruction
MMH-1 Psychotropic Medication Informed Consent MMH-1 Psychotropic Medication Informed Consent_Final.pdf	Form and Instruction
MMH-1 Psychotropic Medication Informed Consent MMH-1 Psychotropic Medication Informed Consent_Final.pdf	Form and Instruction

IC Title:

Psychotropic Medication Informed Consent (Form MMH-1)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 410.1310

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	MMH-1				Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title: 09-80-0321 ORR Division of Children's Services Records

FR Citation: 81 FR 46682

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, 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	600	600
Annual IC Time Burden (Hours)	900	900
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.

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