Information Collection

MH-CLD BCI Data

IC 219072 under ICR 202412-0930-004 · OMB 0930-0335.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form MHBG Tables 2021 MH-CLD BCI Data	Form and Instruction
Form MHBG Tables 2021 MHBG Tables 2021 MH-CLD BCI Data	Form and Instruction
MHBG Tables 2021 MHBG Tables 2021 Attachment A4- 2021 TEDS- MHBG Application URS Tables.xls	Form and Instruction
MHBG Tables 2021 MHBG Tables 2021 Attachment A4- 2021 TEDS- MHBG Application URS Tables.xls	Form and Instruction

IC Title:

MH-CLD BCI Data

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Voluntary

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	MHBG Tables 2021				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-30	30
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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