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Youth
National Evaluation of the Comprehensive Mental Health Services for Children and Their Families Program: Phase VI
OMB: 0930-0307
IC ID: 190421
OMB.report
HHS/SAMHSA
OMB 0930-0307
ICR 201503-0930-003
IC 190421
( )
Documents and Forms
Document Name
Document Type
Form Youth
Youth
Form and Instruction
Youth Youth
Youth - Instruments.pdf
Form and Instruction
Youth - Other.pdf
Youth - Other
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Youth
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
Youth
Youth
Youth - Instruments.pdf
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:
1,504
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
11,731
0
-19,360
0
0
31,091
Annual IC Time Burden (Hours)
2,682
0
-3,406
0
0
6,088
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Youth - Other
Youth - Other.pdf
03/25/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.