Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Behavioral Health Consultation Provider Semi-Structured Interview (SSI) New 67 50 0 Form and Instruction B8
Form and Instruction B16
Care Coordinator Semi-Structured Interview (SSI) New 67 50 0 Form and Instruction B5
Form and Instruction B13
Champion Semi-Structured Interview New 67 34 0 Form and Instruction B7
Form and Instruction B15
Community-based and Other Resources Semi-Structured Interview (SSI) New 50 25 0 Form and Instruction B6
Form and Instruction B14
Health Professional Survey New 23256 7674 0 Form and Instruction B1
Form and Instruction B9
Practice-Level Survey New 6172 2037 0 Form and Instruction B2
Form and Instruction B10
Program Implementation Semi-Structured Interview (SSI) New 134 134 0 Form and Instruction B4
Form and Instruction B12
Program Implementation Survey New 67 22 0 Form and Instruction B3
Form and Instruction B11
Total burden requested under this ICR: 29880 10026 0  
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