OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Primary and Behavioral Health Care Integration Evaluation

OMB 0930-0365 · HHS/SAMHSA.

OMB 0930-0365

Latest Forms, Documents, and Supporting Material

Document Name
Form Client Health Asse SMI Clients Form and Instruction
Form Electronic Data Co Extraction of Grantee Registry/EHR Data Form and Instruction
Form Electronic Data Co Focus Groups Form and Instruction
Form On-site Staff Inte Grantee - Site Visits Form and Instruction
Form Telephone Intervie Grantee Director - Phone Form and Instruction
Form Staff Survey Grantee Frontline Staff Survey Form and Instruction
Form Director Survey Grantee Director - Web Form and Instruction
OMB_Part B Final PBHCI 6 24 2016.docx Supporting Statement B
OMB_Part A FINAL PBHCI 6 24 2016.docx Supporting Statement A
Comparison Group Clinic Director Coordination Instruction
SMI Clients Form and Instruction
Extraction of Grantee Registry/EHR Data Form and Instruction
Focus Groups Form and Instruction
Grantee - Site Visits Form and Instruction
Grantee Director - Phone Form and Instruction
Grantee Frontline Staff Survey Form and Instruction
Grantee Director - Web Form and Instruction

All Historical Document Collections

201605-0930-003

Approved without change

New collection (Request for a new OMB Control Number)

2016-06-29