View Information Collection (IC)

View Information Collection (IC)

Program Staff Questionnaires (Form M-11A-K) - Recordkeeping
 
No Unchanged
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form M-11A Program Director Questionnaire Program Director Questionnaire (Form M-11A).docx Yes Yes Fillable Fileable
Form and Instruction Form M-11B LTFC Program Director Questionnaire LTFC Program Director Questionnaire (Form M-11B).docx Yes Yes Fillable Fileable
Form and Instruction Form M-11C Clinician Questionnaire Clinician Questionnaire (Form M-11C).docx Yes Yes Fillable Fileable
Form and Instruction Form M-11D LTFC Clinician Questionnaire LTFC Clinician Questionnaire (Form M-11D).docx Yes Yes Fillable Fileable
Form and Instruction Form M-11E Case Manager Questionnaire Case Manager Questionnaire (Form M-11E).docx Yes Yes Fillable Fileable
Form and Instruction Form M-11F LTFC Case Manager Questionnaire LTFC Case Manager Questionnaire (Form M-11F).docx Yes Yes Fillable Fileable
Form and Instruction Form M-11G Education Staff Questionnaire Education Staff Questionnaire (Form M-11G).docx Yes Yes Fillable Fileable
Form and Instruction Form M-11H LTFC Educational Staff Questionnaire LTFC Educational Staff Questionnaire (Form M-11H).docx Yes Yes Fillable Fileable
Form and Instruction Form M-11I Medical Coordinator Questionnaire Medical Coordinator Questionnaire (Form M-11I).docx Yes Yes Fillable Fileable
Form and Instruction Form M-11J Youth Care Worker Questionnaire Youth Care Worker Questionnaire (Form M-11J).docx Yes Yes Fillable Fileable
Form and Instruction Form M-11K PSA Compliance Manager Questionnaire PSA Compliance Manager Questionnaire (Form M-11K).docx Yes Yes Fillable Fileable

Community and Social Services Social Services

 

4 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved 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 216 0 0 0 0 216
Annual IC Time Burden (Hours) 216 0 0 0 0 216
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.