Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Client-level Data for Community Program Level - Baseline New 1000 520 0 Form and Instruction GPRA Client Outcome Measures Tool
Client-level Data for Community Program Level - Discharge New 520 270 0 Form and Instruction GPRA Client Outcome Measures Tool
Client-level Data for Community Program Level - Follow-up New 800 416 0 Form and Instruction GPRA Client Outcome Measures Tool
Community Program Clinical Staff - Baseline New 80 120 0 Form and Instruction Community-Program Clinical Staff Baseline
Community Program Clinical Staff - Time 2 New 80 120 0 Form and Instruction Community-Program Clinical Staff Time 2
Community Program Clinical Staff - Time 2 New 20 30 0 Form and Instruction Community-Program Director Time 2
Community Program Data Manager - Baseline New 20 30 0 Form and Instruction Community-Program Data Manager Baseline
Community Program Data Manager - Time 2 New 20 30 0 Form and Instruction Community-Program Data Manager Time 2
Community Program Director - Baseline New 20 30 0 Form and Instruction Community-Program Director Baseline
Community Program Director - Baseline New 20 60 0 Form and Instruction Community-Program Director Baseline
Community Program Director - Time 2 New 20 60 0 Form and Instruction Community-Program Director Time 2
Community Program Director - Time 3 New 20 60 0 Form and Instruction Community-Program Director Time 3
State Interview Protocol - Time 1 New 57 86 0 Form and Instruction State Director Time 1 Interview Protocol
State Interview protocol - Time 2 New 57 86 0 Form and Instruction State Director Time 2 Interview Protocol
State Survey - Baseline New 57 228 0 Form and Instruction State Director Baseline Survey
State Survey - Time 2 New 57 228 0 Form and Instruction State Director Time 2 Survey
State Survey - Time 3 New 57 228 0 Form and Instruction State Director Time 3 Survey
Total burden requested under this ICR: 2905 2602 0  
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