Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Asessment and Referral Tool New 2800 700 0 Form and Instruction N/A Adult Assessment and Referral tool
Form and Instruction N/A Child Youth Assessment and Referral Tool
Group Encounter Log New 3300 231 0 Form and Instruction N/A Group Encounter Log
Individual/Family Crisis Counseling Servies Encounter Log Modified 39200 5096 0 Form and Instruction N/A Individual Family Encounter Form
Particpant Feedback Form New 1000 250 0 Form and Instruction N/A Participant Feedback Form
Service Provider Feedback Form New 100 25 0 Form and Instruction N/A Service Provider Feedback Form
Weekly Tally Sheet New 6600 1320 0 Form and Instruction N/A Weekly Tally Sheet
Total burden requested under this ICR: 53000 7622 0  
To view an IC, click on IC Title