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Federal forms, ICRs, and supporting documents

Information Collection

Assessing State Programs' Community-Clinical Linkages and Related Technical Assistance Needs

IC 200759 under ICR 201008-0920-003 · OMB 0920-0864.

Documents and Forms
Document Name
Document Type
Form
Form
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

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Assessing State Programs' Community-Clinical Linkages and Related Technical Assistance Needs
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Assessing Community-Clinical Linkages Attachment 1_NHDSP Survey Screenshots.pdf Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

51 0
   
State, Local, and Tribal Governments
 
   100 %

  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 51 0 0 0 0 0
Annual IC Time Burden (Hours) 21 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement A 0920-0864_IC 5_SS A_1 09 2012.docx 01/09/2012
Supporting Statement B 0920-0864_IC 5_SS B_1 09 2012.docx 01/09/2012
Intro email Attachment 2_NHDSP Introductory Email.docx 01/09/2012
Invitation email Attachment 3_NHDSP Invitation Email.docx 01/09/2012
Reminder email Attachment 4_NHDSP Reminder Email.docx 01/09/2012
Thank you email Attachment 5_NHDSP Thank You Email.docx 01/09/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.