Care Coordinator 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

Documents and Forms

Document Name Document Type
Form 1J 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
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
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

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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1J	Attachment 1J - Care Coordinator SSI PMHCA	Attachment B5 - Care Coordinator SSI, V2, 2021-2023 PMHCA_NON-APPROVED_OMB.docx	Yes	Yes	Fillable Fileable
Form and Instruction	1B	Attachment 1B - Care Coordinator SSI MMHSUD	Attachment B13 - Care Coordinator SSI, V2, 2023 MMHSUD_NON-APPROVED_OMB.docx	Yes	Yes	Fillable Fileable
Form and Instruction	1B	1B_MCHB_0906-0105_MMHSUD Care Coordinator SSI_Redline	1B_MCHB_0906-0105_MMHSUD Care Coordinator SSI_Redline.docx	Yes	Yes	Fillable Fileable
Form and Instruction	1J	1J_MCHB_0906-0105_PMHCA Care Coordinator SSI_Redline	1J_MCHB_0906-0105_PMHCA Care Coordinator SSI_Redline.docx	Yes	Yes	Fillable Fileable

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 %

	Requested	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

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.