Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Augmentation Screener Modified 1300 104 0 Form and Instruction Augmentation Screener Questionnaire Augmentation Screener Questionnaire
I-TF Facility Registration Application Form Modified 1500 120 0 Form and Instruction I-TF Facility Registration Application Form I-TF Facility Registration Application Form
I-TF Online State Add Update Form Modified 3050 244 0 Form and Instruction I-TF Online State Add Update Form I-TF Online State Add Update Form
N-SUMHSS (both SU and MH) Modified 5000 6400 0 Form and Instruction N-SUMHSS Questionnaire N-SUMHSS Questionnaire
N-SUMHSS (either SU or MH) Modified 32000 26560 0 Form and Instruction N-SUMHSS Questionnaire N-SUMHSS Questionnaire
N-SUMHSS BC Modified 1500 1125 0 Form and Instruction N-SUMHSS Between Cycle Questionnaire N-SUMHSS Between Cycle Questionnaire
N-SUMHSS EHR Supplement New 37000 4440 0 Form and Instruction N-SUMHSS EHR Supplement N-SUMHSS EHR Supplement
N-SUMHSS VA Supplement New 800 40 0 Form and Instruction N-SUMHSS VA Supplement N-SUMHSS VA Supplement
Total burden requested under this ICR: 82150 39033 0  
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