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The Strategic Prevention Framework State Incentive Grant (SPF SIG) State-Level Interview Protocols
The Strategic Prevention Framework State Incentive Grant (SPF SIG) State-Level Interview Protocols
OMB: 0930-0279
IC ID: 43645
OMB.report
HHS/SAMHSA
OMB 0930-0279
ICR 200610-0930-005
IC 43645
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0279 can be found here:
2013-11-13 - Reinstatement with change of a previously approved collection
2011-05-02 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form CLI - Part I
The Strategic Prevention Framework State Incentive Grant (SPF SIG) State-Level Interview Protocols
Form and Instruction
CLI - Part I CLI - Part I
CLI Part I instrument OMB version 8-3-06 sent to CSAP .doc
Form and Instruction
CLI - Part II CLI - Part II
CLI Part II instrument OMB version 8-3-06 sent to CSAP.doc
Form and Instruction
CLI OMB Appendices A-E 8-03-06.doc
CLI - Appendices A-E
IC Document
CLI OMB Appendices F-O 5-22-06.doc
CLI - Appendices F-O
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
The Strategic Prevention Framework State Incentive Grant (SPF SIG) State-Level Interview Protocols
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
CLI - Part I
CLI - Part I
CLI Part I instrument OMB version 8-3-06 sent to CSAP .doc
No
No
Paper Only
Form and Instruction
CLI - Part II
CLI - Part II
CLI Part II instrument OMB version 8-3-06 sent to CSAP.doc
No
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
390
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
50 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
390
0
338
0
0
52
Annual IC Time Burden (Hours)
6,856
0
6,622
0
0
234
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
CLI - Appendices A-E
CLI OMB Appendices A-E 8-03-06.doc
10/13/2006
CLI - Appendices F-O
CLI OMB Appendices F-O 5-22-06.doc
10/13/2006
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.