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State and Territory Cooperative Agreements
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction State/Territory: Monthly Key Metrics State/Territory: Monthly Key Metrics State and Territory Instrument 1 _ Monthly Key Metrics 4.5.23.docx Yes Yes Fillable Fileable
Form and Instruction State/Territory: Chat and Text Report State/Territory: Chat and Text Report State and Territory Instrument 5 _ Chat & Text Report 4.5.23.docx Yes Yes Fillable Fileable
Form and Instruction State/Territory: Communications Plan State/Territory: Communications Plan State and Territory Instrument 6 _ Comm Plan 4.5.23.docx Yes Yes Fillable Fileable
Form and Instruction State/Territory: Mobile Crisis and 988-911 reports State/Territory: Mobile Crisis and 988-911 reports State and Territory Instrument 8 _ Mobile Crisis - 988 Report 4.5.23.docx Yes Yes Fillable Fileable
Form and Instruction State/Territory: Cohort 2 Monthly Meeting Agenda State/Territory: Cohort 2: Monthly Meeting Agenda SAMHSA 988 State Territory Grant (Cohort 2) - Monthly Call Agenda (FINAL).docx Yes Yes Fillable Fileable
Form and Instruction State/Territory: Cohort 2 Quarterly Report State/Territory: Cohort 2 Quarterly Report 0930-0394 988 State Territory Grant (Cohort 2) - Qtrly Report Template.docx Yes Yes Fillable Fileable
Form and Instruction State/Territory: Cohort 2 Required Data State/Territory: Cohort 2 Required Data SAMHSA 988 State Territory Grant (Cohort 2) - required data-(FINAL).docx Yes Yes Fillable Fileable
Form and Instruction State/Territory QI Plan State/Territory QI Plan 0930-0394 State and Territory Instrument 3 _ QI Plan (FINAL).docx Yes Yes Fillable Fileable
Form and Instruction State/Territory: Cohort 1 Quarterly Report State/Territory: Cohort 1 Quarterly Report 0930-0394 State and Territory Instrument 2 (COHORT 1) _ Qtrly Report (FINAL).docx Yes Yes Fillable Fileable
Form and Instruction State/Territory: Monthly Call Agenda State/Territory: Monthly Call Agenda 0930-0394 State and Territory Instrument 4 _ Monthly Call Agenda 4 4.5.23.docx Yes Yes Fillable Fileable
Form and Instruction State/Territory: Sustainability Plan State/Territory: Sustainability Plan 0930-0394 State and Territory Instrument 7 _ Sustainability Plan 4.5.23.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

Privacy Act of 1974 (Title 5 United States Code [U.S.C.] 552a)  75 FR 28264

594 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,592 0 0 0 0 2,592
Annual IC Time Burden (Hours) 3,348 0 0 0 0 3,348
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.