Client Interview Instrument-Program Participant

Evaluation of the Assisted Outpatient Treatment Grant Program for Individuals with Serious Mental Illness

Documents and Forms

Document Name Document Type
Attachment B_AOT Evaluation_Structured Client Instrument_Clean.doc Other-interview

Information Collection (IC) Details

IC Title:	Client Interview Instrument-Program Participant	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
Other-interview			Attachment B_AOT Evaluation_Structured Client Instrument_Clean.doc		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 520	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	1,560	1,560
Annual IC Time Burden (Hours)	1,560	1,560
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.