Mental Health Current Evaluation and Treatment Summary Form

Individual Specific Medical Evaluation Forms (15)

OMB: 0420-0550

IC ID: 224328

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

View Information Collection (IC)

Mental Health Current Evaluation and Treatment Summary Form PC-262-14
 
Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction PC-262-14 Mental Health Treatment and Summary Mental Health Treatment and Summary_Revised.docx Yes No Paper Only

International Affairs and Commerce International Development and Humanitarian Aid

 

1,221 0
   
Individuals or Households
 
   0 %

  Requested 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 1,221 0 0 0 0 1,221
Annual IC Time Burden (Hours) 2,137 0 0 0 0 2,137
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Non-substantive Change Justification Justification for revised Mental Health form.docx 09/11/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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