Information Collection

Community-based and Other Resources Semi-Structured Interview (SSI)

IC 271505 under ICR 202505-0906-005 · OMB 0906-0105.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1L Community-based and Other Resources Semi-Structured Interview (SSI)	Form and Instruction
Form 1L Attachment 1L - Community-Based and Other Resources SSI PMHCA Community-based and Other Resources Semi-Structured Interview (SSI)	Form and Instruction
Form 1D Attachment 1D - Community-Based and Other Resources SSI MMHSUD Community-based and Other Resources Semi-Structured Interview (SSI)	Form and Instruction
Form 1D 1D_MCHB_0906-0105_MMHSUD Community Resources SSI_Redline Community-based and Other Resources Semi-Structured Interview (SSI)	Form and Instruction
Form 1L 1L_MCHB_0906-0105_PMHCA Community Resources SSI_Redline Community-based and Other Resources Semi-Structured Interview (SSI)	Form and Instruction
1L Attachment 1L - Community-Based and Other Resources SSI Attachment B6 - Community-Based and Other Resources SSI, V2, 2021-2023 PMHCA_NON-APPROVED_OMB.docx	Form and Instruction
1L Attachment 1L - Community-Based and Other Resources SSI Attachment B6 - Community-Based and Other Resources SSI, V2, 2021-2023 PMHCA_NON-APPROVED_OMB.docx	Form and Instruction
1D Attachment 1D - Community-Based and Other Resources SSI Attachment B14 - Community-Based and Other Resources SSI, V2, 2023 MMHSUD_NON-APPROVED_OMB.docx	Form and Instruction
1D Attachment 1D - Community-Based and Other Resources SSI Attachment B14 - Community-Based and Other Resources SSI, V2, 2023 MMHSUD_NON-APPROVED_OMB.docx	Form and Instruction
1D 1D_MCHB_0906-0105_MMHSUD Community Resources SSI_Redline 1D_MCHB_0906-0105_MMHSUD Community Resources SSI_Redline.docx	Form and Instruction
1D 1D_MCHB_0906-0105_MMHSUD Community Resources SSI_Redline 1D_MCHB_0906-0105_MMHSUD Community Resources SSI_Redline.docx	Form and Instruction
1L 1L_MCHB_0906-0105_PMHCA Community Resources SSI_Redline 1L_MCHB_0906-0105_PMHCA Community Resources SSI_Redline.docx	Form and Instruction
1L 1L_MCHB_0906-0105_PMHCA Community Resources SSI_Redline 1L_MCHB_0906-0105_PMHCA Community Resources SSI_Redline.docx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Community-based and Other Resources 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	1L	Yes	Yes	Fillable Fileable
Form and Instruction	1D	Yes	Yes	Fillable Fileable
Form and Instruction	1D	Yes	Yes	Fillable Fileable
Form and Instruction	1L	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: 50

Number of Respondents for Small Entity: 50

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	50	50
Annual IC Time Burden (Hours)	25	25
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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