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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form MMH-1 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

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	MMH-1	Psychotropic Medication Informed Consent	MMH-1 Psychotropic Medication Informed Consent_Final.pdf		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 %

	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

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.