CSC Staff Interview

Mental Health Block Grant Ten Percent Set Aside Evaluation

Documents and Forms

Document Name Document Type
Form CSC Staff Intervie CSC Staff Interview Form and Instruction
CSC Staff Intervie CSC Staff Interview Attachment 3 - Coordinated Specialty Care (CSC) Program Staff Interview 2-22-17.docx Form and Instruction

Information Collection (IC) Details

IC Title:	CSC Staff Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	CSC Staff Interview	CSC Staff Interview	Attachment 3 - Coordinated Specialty Care (CSC) Program Staff Interview 2-22-17.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 192	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
Annual Number of Responses for this IC	192	192
Annual IC Time Burden (Hours)	384	384
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.