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CMHS Program-Level Data
Common Data Platform
OMB: 0930-0346
IC ID: 213385
OMB.report
HHS/SAMHSA
OMB 0930-0346
ICR 201501-0930-004
IC 213385
( )
Documents and Forms
Document Name
Document Type
Form IPP_RESULT FORM
CMHS Program-Level Data
Form
IPP_RESULT FORM IPP_RESULT FORM
Attachment 3 IPP_RESULT FORM.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
CMHS Program-Level Data
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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
IPP_RESULT FORM
IPP_RESULT FORM
Attachment 3 IPP_RESULT FORM.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
982
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
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
3,928
0
0
0
0
3,928
Annual IC Time Burden (Hours)
7,856
0
0
0
0
7,856
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
