Information Collection

Care Coordinator Semi-Structured Interview (SSI)

IC 271503 under ICR 202505-0906-005 · OMB 0906-0105.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1J Care Coordinator Semi-Structured Interview (SSI)	Form and Instruction
Form 1J Attachment 1J - Care Coordinator SSI PMHCA Care Coordinator Semi-Structured Interview (SSI)	Form and Instruction
Form 1B Attachment 1B - Care Coordinator SSI MMHSUD Care Coordinator Semi-Structured Interview (SSI)	Form and Instruction
Form 1B 1B_MCHB_0906-0105_MMHSUD Care Coordinator SSI_Redline Care Coordinator Semi-Structured Interview (SSI)	Form and Instruction
Form 1J 1J_MCHB_0906-0105_PMHCA Care Coordinator SSI_Redline Care Coordinator Semi-Structured Interview (SSI)	Form and Instruction
1J Attachment 1J - Care Coordinator SSI PMHCA Attachment B5 - Care Coordinator SSI, V2, 2021-2023 PMHCA_NON-APPROVED_OMB.docx	Form and Instruction
1J Attachment 1J - Care Coordinator SSI PMHCA Attachment B5 - Care Coordinator SSI, V2, 2021-2023 PMHCA_NON-APPROVED_OMB.docx	Form and Instruction
1B Attachment 1B - Care Coordinator SSI MMHSUD Attachment B13 - Care Coordinator SSI, V2, 2023 MMHSUD_NON-APPROVED_OMB.docx	Form and Instruction
1B Attachment 1B - Care Coordinator SSI MMHSUD Attachment B13 - Care Coordinator SSI, V2, 2023 MMHSUD_NON-APPROVED_OMB.docx	Form and Instruction
1B 1B_MCHB_0906-0105_MMHSUD Care Coordinator SSI_Redline 1B_MCHB_0906-0105_MMHSUD Care Coordinator SSI_Redline.docx	Form and Instruction
1B 1B_MCHB_0906-0105_MMHSUD Care Coordinator SSI_Redline 1B_MCHB_0906-0105_MMHSUD Care Coordinator SSI_Redline.docx	Form and Instruction
1J 1J_MCHB_0906-0105_PMHCA Care Coordinator SSI_Redline 1J_MCHB_0906-0105_PMHCA Care Coordinator SSI_Redline.docx	Form and Instruction
1J 1J_MCHB_0906-0105_PMHCA Care Coordinator SSI_Redline 1J_MCHB_0906-0105_PMHCA Care Coordinator SSI_Redline.docx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Care Coordinator Semi-Structured Interview (SSI)

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	1J	Yes	Yes	Fillable Fileable
Form and Instruction	1B	Yes	Yes	Fillable Fileable
Form and Instruction	1B	Yes	Yes	Fillable Fileable
Form and Instruction	1J	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)	50	50
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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