Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
SSG Fox SPGP - Annual Grantee Financial Report Modified 90 68 0 Form and Instruction 10-316e
SSG Fox SPGP - Annual Grantee Performance Report Removed 0 0 0 Form 10-316a
SSG Fox SPGP - Application Modified 360 12600 0 Form and Instruction 10-315a
SSG Fox SPGP - Baseline Mental Health Screening Checklist New 8100 2700 0 Form and Instruction 10-317e
SSG Fox SPGP - Columbia Suicide Risk Screening (CSSRS) Removed 0 0 0 Other-Screening Tool
SSG Fox SPGP - Corrective Action Plan (CAP) Modified 25 13 0 Form and Instruction 10-316d
SSG Fox SPGP - Eligibility Screening Modified 16200 8100 0 Form 10-317a
SSG Fox SPGP - Grantee Performance Report Modified 180 90 0 Form 10-316b
SSG Fox SPGP - Intake Form Modified 16200 2700 0 Form and Instruction 10-317b
SSG Fox SPGP - Other Grantee Financial Report Removed 0 0 0 Form and Instruction 10-316f
SSG Fox SPGP - Participant Satisfaction Survey Modified 5000 1250 0 Form 10-317c
SSG Fox SPGP - Program & Budget Change Request Modified 180 45 0 Form 10-316c
SSG Fox SPGP - Program Exit Screening Checklist Modified 8100 2700 0 Form 10-317d
SSG Fox SPGP - Renewal Application Modified 90 900 0 Form and Instruction 10-315b
Total burden requested under this ICR: 54525 31166 0  
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