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

Latest forms, documents, and information collections
DocumentType
Form Client Health Asse Client Health Assessment QuestionnaireForm and Instruction
Form Electronic Data Co Electronic Data Collection ToolForm and Instruction
Form Electronic Data Co Electronic Data Collection ToolForm and Instruction
Form On-site Staff Inte On-site Staff Interview ProtocolForm and Instruction
Form Telephone Intervie Telephone Interview ProtocolForm and Instruction
Form Staff Survey Staff SurveyForm and Instruction
Form Director Survey Director SurveyForm and Instruction
OMB_Part B Final PBHCI 6 24 2016.docxSupporting Statement B
OMB_Part A FINAL PBHCI 6 24 2016.docxSupporting 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All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
201605-0930-003 New collection (Request for a new OMB Control Number) 2016-06-29 Approved without change