Information Collection

CCBHC-E EHR Data Instructions for Grantees

IC 281513 under ICR 202607-0930-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CCBHC-E EHR Data I CCBHC-E EHR Data Instructions for Grantees CCBHC-E EHR Data Instructions for Grantees	Form and Instruction
CCBHC-E EHR Data I CCBHC-E EHR Data Instructions for Grantees CCBHC-E EHR Data Instructions for Grantees.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CCBHC-E EHR Data Instructions for Grantees				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: CCBHC

FR Citation: 74 FR 28264

Number of Respondents: 298

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	596	596
Annual IC Time Burden (Hours)	4,768	4,768
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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