Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Asessment and Referral Tool Modified 2800 700 0 Form and Instruction Adult_Assessment_and_Referral_Tool Adult_Assessment_and_Referral_Tool
Form and Instruction Child_Youth_Assessment_and_Referral Child_Youth_Assessment_and_Referral
Group Encounter Log Modified 3300 231 0 Form and Instruction Group_Encounter_Log Group_Encounter_Log
Individual/Family Crisis Counseling Servies Encounter Log Modified 39200 5096 0 Form and Instruction Individual_Family_Encounter_Form Individual_Family_Encounter_Form
Particpant Feedback Form Modified 1000 250 0 Form and Instruction Participant_Feedback_Form Participant_Feedback_Form
Service Provider Feedback Form Modified 100 41 0 Form and Instruction Service_Provider_Feedback_Form Service_Provider_Feedback_Form
Weekly Tally Sheet Modified 6600 1320 0 Form and Instruction Weekly_Tally_Sheet Weekly_Tally_Sheet
Total burden requested under this ICR: 53000 7638 0  
To view an IC, click on IC Title