View Information Collection (IC)

View Information Collection (IC)

IC Title:	GenIC #43 (Extension w/o change): Section 223 Demonstration Programs to Improve Community Mental Health Services	Agency IC Tracking Number:

IC Status: New

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
Instruction			43 - CCBHC Cost Report Instructions 508c 11 10 15.pdf		No		Printable Only
Instruction			43 - State Demonstration Proposal Application and Guidance_100515f_revised 101515_submitted (3).pdf		No		Printable 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: 97	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	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	121	0	121	0	0	0
Annual IC Time Burden (Hours)	7,490	0	7,490	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
#43 - Supporting Statement	43 - Supporting Statement Demonstration Programs CLEAN.docx	01/11/2018

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