Program Implementation 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 1O Program Implementation Semi-Structured Interview (SSI) Form and Instruction
1O Attachment 1O - Program Implementation SSI PMHCA Attachment B4 - Program Implementation SSI, V3, 2021-2023 PMHCA_NON-APPROVED_OMB.docx Form and Instruction
1G Attachment 1G - Program Implementation SSI MMHSUD Attachment B12 - Program Implementation SSI, V2, 2023 MMHSUD_NON-APPROVED_OMB.docx Form and Instruction
1G 1G_MCHB_0906-0105_MMHSUD Program Implementation SSI_Redl 1G_MCHB_0906-0105_MMHSUD Program Implementation SSI_Redline.docx Form and Instruction
1O 1O_MCHB_0906-0105_MCHB_PMHCA Program Implementation SSI_ 1O_MCHB_0906-0105_MCHB_PMHCA Program Implementation SSI_Redline.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Program Implementation 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	1O	Attachment 1O - Program Implementation SSI PMHCA	Attachment B4 - Program Implementation SSI, V3, 2021-2023 PMHCA_NON-APPROVED_OMB.docx	Yes	Yes	Fillable Fileable
Form and Instruction	1G	Attachment 1G - Program Implementation SSI MMHSUD	Attachment B12 - Program Implementation SSI, V2, 2023 MMHSUD_NON-APPROVED_OMB.docx	Yes	Yes	Fillable Fileable
Form and Instruction	1G	1G_MCHB_0906-0105_MMHSUD Program Implementation SSI_Redline	1G_MCHB_0906-0105_MMHSUD Program Implementation SSI_Redline.docx	Yes	Yes	Fillable Fileable
Form and Instruction	1O	1O_MCHB_0906-0105_MCHB_PMHCA Program Implementation SSI_Redline	1O_MCHB_0906-0105_MCHB_PMHCA Program Implementation 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: 134	Number of Respondents for Small Entity: 134

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	134	134
Annual IC Time Burden (Hours)	134	134
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.