Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Assessment and Referral Tool Modified 14250 2423 0 Form and Instruction Adult Assessment and Referral Tool
Form and Instruction Child Assessment and Referral Tool
Group Encounter Log Modified 24750 1238 0 Form and Instruction Group Encounter Log
Individual/Family Crisis Counseling Services Encounter Log Modified 285000 22800 0 Form and Instruction Individual/Family Services Encounter Log
Participant Feedback Form Modified 2000 500 0 Form and Instruction Participant Feedback Form
Service Provider Feedback Form Modified 750 308 0 Form and Instruction Service Provider Feedback Form
Weekly Tally Sheet Modified 78000 11700 0 Form and Instruction Weekly Tally Sheet
Total burden requested under this ICR: 404750 38969 0  
To view an IC, click on IC Title