Case Manager, Treatment, Housing Staff/provider Interview

Evaluation of Programs to Provide Services to Persons Who Are Homeless with Mental and /or Substance Use Disorders

Documents and Forms

Document Name Document Type
Form SV Guide_Cost Ques Case Manager, Treatment, Housing Staff/provider Interview Form and Instruction
SV Guide_Cost Ques SV Guide_Cost Questionnaire Attachment 2_SV Guide_Cost Questionnaire.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Case Manager, Treatment, Housing Staff/provider Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SV Guide_Cost Questionnaire	SV Guide_Cost Questionnaire	Attachment 2_SV Guide_Cost Questionnaire.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 540	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	540	165	375
Annual IC Time Burden (Hours)	1,080	330	750
Annual IC Cost Burden (Dollars)	0	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.