Information Collection

Child and Adolescent Psychiatric Assessment : Child Version

IC 196125 under ICR 201102-0920-008 · OMB 0920-0884.

Documents and Forms

Document Name Document Type
Form 13 Child and Adolescent Psychiatric Assessment : Child Version Form and Instruction
13 Child and Adolescent Psychiatric Assessment : Child Vers Att E 1 CAPA (Child) E1-E50.pdf Form and Instruction
14 Child and Adolescent Psychiatric Assessment : Child Vers Att E 2 CAPA (Child) pp E51 - E100.pdf Form and Instruction
15 Child and Adolescent Psychiatric Assessment : Child Vers Att E 3 CAPA (Child) pp E101 - E150.pdf Form and Instruction
16 Child and Adolescent Psychiatric Assessment : Child Vers Att E 4 CAPA (Child) E151 - E203.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Child and Adolescent Psychiatric Assessment : Child Version	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	13	Child and Adolescent Psychiatric Assessment : Child Version	Att E 1 CAPA (Child) E1-E50.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	14	Child and Adolescent Psychiatric Assessment : Child Version	Att E 2 CAPA (Child) pp E51 - E100.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	15	Child and Adolescent Psychiatric Assessment : Child Version	Att E 3 CAPA (Child) pp E101 - E150.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	16	Child and Adolescent Psychiatric Assessment : Child Version	Att E 4 CAPA (Child) E151 - E203.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U. S. Population	FR Citation: 49 FR 37693

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	225	225
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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