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State Official Interviews
Evaluation of the Extension of the Certified Community Behavioral Health Clinic (CCBHC) Demonstration Program
OMB: 0990-0485
IC ID: 255614
OMB.report
HHS/HHSDM
OMB 0990-0485
ICR 202208-0990-007
IC 255614
( )
Documents and Forms
Document Name
Document Type
Attachment A. CCBHC State Official Interview Protocol_Year 2.docx
Other-Interview Protocol
Attachment A. CCBHC State Official Interview Protocol_Year 2.docx
Other-Interview Protocol
Attachment B. CCBHC State Official Interview Protocol_Year 3.docx
CCBHC State Official Interview Protocol Year 3
IC Document
Attachment B. CCBHC State Official Interview Protocol_Year 3.docx
CCBHC State Official Interview Protocol Year 3
IC Document
Attachment C. CCHBC State Official Interview Protocol_Year 4.docx
CCBHC State Official Interview Protocol Year 4
IC Document
Attachment C. CCHBC State Official Interview Protocol_Year 4.docx
CCBHC State Official Interview Protocol Year 4
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
State Official Interviews
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 Protocol
Attachment A. CCBHC State Official Interview Protocol_Year 2.docx
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
27
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
Approved
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
27
0
27
0
0
0
Annual IC Time Burden (Hours)
27
0
27
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
CCBHC State Official Interview Protocol Year 3
Attachment B. CCBHC State Official Interview Protocol_Year 3.docx
08/25/2022
CCBHC State Official Interview Protocol Year 4
Attachment C. CCHBC State Official Interview Protocol_Year 4.docx
08/25/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.