OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Evaluation of SAMHSA Primary Care Behavioral Health Integration Grant Program

OMB 0990-0371 · HHS/HHSDM.

OMB 0990-0371

Latest Forms, Documents, and Supporting Material

Document Name
OMB Supporting Statment Part B 9 23 11_V3.docx Supporting Statement B
OMB Supporting Statement Part A Full Pkg 9 23 11_V4.docx Supporting Statement A
Grantee Key Staff- Web Survey Other-survey
SMI Clients- Clients Exam and Survey-Follow-up Other-form
Grantee Project Directors- Quarterly Reports Other-form
Grantee Data - Individual Service Utilization Data Other-survey
Grantee Data Staff -TRAC Indicators Other-surve
Control Site leadership - Site visit Interview Other-survey
Care coordinators interivew Other-survey
MH Provider Interview Other-survey
Grantee PH Providers- Site Visit Interview Other-survey
Grantee Leadership (Sites Visit Interview) Other-interview
SMI Clients -Client Exam and Survey-Baseline Other-survey

All Historical Document Collections

201107-0990-004 Approved with change	Revision of a currently approved collection	2011-07-27
201102-0990-002 Approved with change	New collection (Request for a new OMB Control Number)	2011-02-04