Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Assessment and Referral Tool Modified 7200 1224 0 Form and Instruction Adult Assessment and Referral Tool Adult Assessment and Referral Tool
Child/Youth Assessment and Referral Tool New 800 64 0 Form and Instruction Child/Youth Assessment and Referral Tool Child/Youth Assessment and Referral Tool
Group Encounter Log Modified 13200 1056 0 Form and Instruction Group Encounter Log Group Encounter Log
Individual/Family Crisis Counseling Services Encounter Log Modified 160000 20800 0 Form and Instruction Individual/Family Crisis Counseling Services Encou Individual/Family Crisis Counseling Services Encounter Log
Participant Feedback Form Modified 4000 1200 0 Form and Instruction Participant Feedback Survey Form Participant Feedback Survey Form
Service Provider Feedback Form Modified 400 120 0 Form and Instruction Service Provider Feedback Form Service Provider Feedback Form
Weekly Tally Sheet Modified 41600 8320 0 Form and Instruction Weekly Tally Sheet Weekly Tally Sheet
Total burden requested under this ICR: 227200 32784 0  
To view an IC, click on IC Title