Behavioral Health Consultation Provider Semi-Structured Interview (SSI)

Evaluation of the Maternal and Child Health Bureau Pediatric Mental Health Care Access and Screening and Treatment for Maternal Mental Health and Substance Use Disorders Programs Project

OMB: 0906-0105

IC ID: 271502

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Behavioral Health Consultation Provider Semi-Structured Interview (SSI)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1I Attachment 1I - Behavioral Health Consultation Provider SSI PMHCA Attachment B8 - Behavioral Health Consultation Provider SSI, V1, 2021-2023 PMHCA_NON-APPROVED_OMB.docx Yes Yes Fillable Fileable
Form and Instruction 1A Attachment 1A - Behavioral Health Consultation Provider SSI MMHSUD Attachment B16 - Behavioral Health Consultation Provider SSI, V1, 2023 MMHSUD_NON-APPROVED_OMB.docx Yes Yes Fillable Fileable
Form and Instruction 1A 1A_MCHB_0906-0105_MMHSUD BH Consultation Provider SSI_Redline 1A_MCHB_0906-0105_MMHSUD BH Consultation Provider SSI_Redline.docx Yes Yes Fillable Fileable
Form and Instruction 1I 1I_MCHB_0906-0105_PMHCA BH Consultation Provider SSI_Redline 1I_MCHB_0906-0105_PMHCA BH Consultation Provider SSI_Redline.docx Yes Yes Fillable Fileable

Health Health Care Services

 

67 67
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 67 0 0 0 0 67
Annual IC Time Burden (Hours) 50 0 0 0 0 50
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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