Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Behavioral Health Consultation Provider Semi-Structured Interview (SSI) Modified 67 50 0 Form and Instruction 1I
Form and Instruction 1A
Form and Instruction 1A
Form and Instruction 1I
Care Coordinator Semi-Structured Interview (SSI) Modified 67 50 0 Form and Instruction 1J
Form and Instruction 1B
Form and Instruction 1B
Form and Instruction 1J
Champion Semi-Structured Interview Modified 67 34 0 Form and Instruction 1K
Form and Instruction 1C
Form and Instruction 1C
Form and Instruction 1K
Community-based and Other Resources Semi-Structured Interview (SSI) Modified 50 25 0 Form and Instruction 1L
Form and Instruction 1D
Form and Instruction 1D
Form and Instruction 1L
Health Professional Survey Modified 23256 7674 0 Form and Instruction 1M
Form and Instruction 1E
Form and Instruction 1E
Form and Instruction 1M
Practice-Level Survey Modified 6172 2037 0 Form and Instruction 1N
Form and Instruction 1F
Form and Instruction 1F
Form and Instruction 1N
Program Implementation Semi-Structured Interview (SSI) Modified 134 134 0 Form and Instruction 1O
Form and Instruction 1G
Form and Instruction 1G
Form and Instruction 1O
Program Implementation Survey Modified 67 22 0 Form and Instruction 1P
Form and Instruction 1H
Form and Instruction 1H
Form and Instruction 1P
Total burden requested under this ICR: 29880 10026 0  
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