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Project Director Interview
Evaluation of Programs to Provide Services to Persons Who Are Homeless with Mental and /or Substance Use Disorders
OMB: 0930-0339
IC ID: 210019
OMB.report
HHS/SAMHSA
OMB 0930-0339
ICR 201701-0930-003
IC 210019
( )
Documents and Forms
Document Name
Document Type
Form Discussion Guide_C
Project Director Interview
Form and Instruction
Discussion Guide_C Discussion Guide_Cost Questionnaire
Attachment 02_SV Discussion Guide_Cost Questionnaire.docx
Form and Instruction
Attachment 06 and 07_Staff and Client SiteVisit Consent.docx
Staff and Client SiteVisit Consent
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Project Director Interview
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Removed
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
Discussion Guide_Cost Questionnaire
Discussion Guide_Cost Questionnaire
Attachment 02_SV Discussion Guide_Cost Questionnaire.docx
Yes
Yes
Fillable Printable
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:
250
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
0
0
-250
0
0
250
Annual IC Time Burden (Hours)
0
0
-500
0
0
500
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Staff and Client SiteVisit Consent
Attachment 06 and 07_Staff and Client SiteVisit Consent.docx
01/13/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.