SAMHSA Application for Peer Grant Reviewers

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0255 can be found here:

Documents and Forms

Document Name Document Type
Form Peer Review\RCI Fo SAMHSA Application for Peer Grant Reviewers Form and Instruction
Peer Review\RCI Fo Peer Review\RCI Form RCI Form_2016.docx Form and Instruction
Public Burden Statement.doc Public Burden Statement IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SAMHSA Application for Peer Grant Reviewers	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	Peer Review\RCI Form	Peer Review\RCI Form	RCI Form_2016.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	750	750
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Public Burden Statement	Public Burden Statement.doc	08/17/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.