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 can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
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All Historical Document Collections

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

OMB Details

Individual/Family Crisis Counseling Services Encounter Log

Federal Enterprise Architecture: Health - Public Health Monitoring

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.