OMB control number

Toolkit Protocol for the Crisis Counseling Assistance and Training Program (CCP)

OMB 0930-0270 · HHS/SAMHSA.

OMB 0930-0270

Data collection about services delivered and users of the services will be collected from the CCPs through standardized information tools which will then be reported to SAMHSA for appropriate processing and analysis. CCPs will be required to use the tools for data collection throughout the life of the program.

The latest form for Toolkit Protocol for the Crisis Counseling Assistance and Training Program (CCP) expires 2029-03-31 and is listed under ICR 202601-0930-001.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form Individual/Family Individual/Family Crisis Counseling Services Encounter Log	Form and Instruction
Form Individual/Family Individual/Family Crisis Counseling Services Encounter Log	Form and Instruction
Form Child/Youth Assess Child/Youth Assessment and Referral Tool	Form and Instruction
Form 0930-0270 DTAC-CCP 0930-0270 DTAC-CCP_Service Provider Feedback Form (document unavailable)	Form and Instruction
Form Service Provider F Service Provider Feedback Form	Form and Instruction
Form Participant Feedba Participant Feedback Survey Form	Form and Instruction
Form Adult Assessment a Adult Assessment and Referral Tool	Form and Instruction
Form Adult Assessment a Assessment and Referral Tool	Form and Instruction
Form Weekly Tally Sheet Weekly Tally Sheet	Form and Instruction
Form Group Encounter Lo Group Encounter Log	Form and Instruction
0930-0270 DTAC CCP Supporting Statement B (SSB)_06062025-DRAFT CLEAN.docx	Supporting Statement B
0930-0270 DTAC CCP Supporting Statement A (SSA)_03_19_26_final.docx	Supporting Statement A
Individual/Family Crisis Counseling Services Encounter Log	Form and Instruction
Individual/Family Crisis Counseling Services Encounter Log	Form and Instruction
Child/Youth Assessment and Referral Tool	Form and Instruction
Child/Youth Assessment and Referral Tool	Form and Instruction
Service Provider Feedback Form	Form and Instruction
Service Provider Feedback Form	Form and Instruction
Participant Feedback Form	Form and Instruction
Participant Feedback Form	Form and Instruction
Assessment and Referral Tool	Form and Instruction
Assessment and Referral Tool	Form and Instruction
Weekly Tally Sheet	Form and Instruction
Weekly Tally Sheet	Form and Instruction
Group Encounter Log	Form and Instruction
Group Encounter Log	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202601-0930-001	Reinstatement without change of a previously approved collection	2026-01-13	Approved with change
202206-0930-002	Revision of a currently approved collection	2022-07-01	Approved without change
201901-0930-004	Reinstatement without change of a previously approved collection	2019-01-31	Approved with change
201507-0930-001	Revision of a currently approved collection	2015-07-30	Approved without change
201203-0930-002	Revision of a currently approved collection	2012-03-20	Approved with change
200809-0930-002	Revision of a currently approved collection	2008-09-18	Approved with change
200507-0930-001	New collection (Request for a new OMB Control Number)	2005-07-06	Approved with change

OMB Details

Individual/Family Crisis Counseling Services Encounter Log

Federal Enterprise Architecture: Health - Public Health Monitoring

Information collection instruments
Form	Name	Electronic access	Type
Form Individual/Family Crisis Counseling Services Encou	Individual/Family Crisis Counseling Services Encounter Log	Fillable Fileable	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.