Information Collection

Program Implementation Survey

IC 271501 under ICR 202505-0906-005 · OMB 0906-0105.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1P Program Implementation Survey	Form and Instruction
Form 1P Attachment 1P - Program Implementation Survey PMHCA Program Implementation Survey	Form and Instruction
Form 1H Attachment 1H - Program Implementation Survey MMHSUD Program Implementation Survey	Form and Instruction
Form 1H 1H_MCHB_0906-0105_MMHSUD Program Implementation Survey_Redline Program Implementation Survey	Form and Instruction
Form 1P 1P_MCHB_0906-0105_PMHCA Program Implementation Survey_Redline Program Implementation Survey	Form and Instruction
1P Attachment 1P - Program Implementation Survey PMHCA Attachment B3 - Program Implementation Survey, V3, 2021-2023 PMHCA_NON-APPROVED_OMB.docx	Form and Instruction
1P Attachment 1P - Program Implementation Survey PMHCA Attachment B3 - Program Implementation Survey, V3, 2021-2023 PMHCA_NON-APPROVED_OMB.docx	Form and Instruction
1H Attachment 1H - Program Implementation Survey MMHSUD Attachment B11 - Program Implementation Survey, V2, 2023 MMHSUD_NON-APPROVED_OMB.docx	Form and Instruction
1H Attachment 1H - Program Implementation Survey MMHSUD Attachment B11 - Program Implementation Survey, V2, 2023 MMHSUD_NON-APPROVED_OMB.docx	Form and Instruction
1H 1H_MCHB_0906-0105_MMHSUD Program Implementation Survey_R 1H_MCHB_0906-0105_MMHSUD Program Implementation Survey_Redline.docx	Form and Instruction
1H 1H_MCHB_0906-0105_MMHSUD Program Implementation Survey_R 1H_MCHB_0906-0105_MMHSUD Program Implementation Survey_Redline.docx	Form and Instruction
1P 1P_MCHB_0906-0105_PMHCA Program Implementation Survey_Re 1P_MCHB_0906-0105_PMHCA Program Implementation Survey_Redline.docx	Form and Instruction
1P 1P_MCHB_0906-0105_PMHCA Program Implementation Survey_Re 1P_MCHB_0906-0105_PMHCA Program Implementation Survey_Redline.docx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Program Implementation Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1P	Yes	Yes	Fillable Fileable
Form and Instruction	1H	Yes	Yes	Fillable Fileable
Form and Instruction	1H	Yes	Yes	Fillable Fileable
Form and Instruction	1P	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 67

Number of Respondents for Small Entity: 67

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	Previously Approved
Annual Number of Responses for this IC	67	67
Annual IC Time Burden (Hours)	22	22
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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