Champion and Community Resources SSI

Evaluation of the Maternal and Child Health Bureau Pediatric Mental Health Care Access Program and the Screening and Treatment for Maternal Depression and Related Behavioral Disorders Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0074 can be found here:

Documents and Forms

Document Name Document Type
Attachment B5 - PMHCA Champion SSI - Copy.docx Other-Semi Structured Interveiw
Attachment B5 - PMHCA Champion SSI - Copy.docx Other-Semi Structured Interveiw
Attachment B6 - MDRBD Champion SSI - Copy.docx Other-Semi Structured Interview
Attachment B6 - MDRBD Champion SSI - Copy.docx Other-Semi Structured Interview
Attachment B9 - PMHCA Community Resources SSI - Copy.docx Other-Semi Structured Interview
Attachment B9 - PMHCA Community Resources SSI - Copy.docx Other-Semi Structured Interview
Attachment B10 - MDRBD Community Resources SSI - Copy.docx Other-Semi Structured Interview
Attachment B10 - MDRBD Community Resources SSI - Copy.docx Other-Semi Structured Interview

Information Collection (IC) Details

IC Title:	Champion and Community Resources SSI	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Semi Structured Interveiw	Attachment B5 - PMHCA Champion SSI - Copy.docx	Yes	Yes	Fillable Fileable
Other-Semi Structured Interview	Attachment B6 - MDRBD Champion SSI - Copy.docx	Yes	Yes	Fillable Fileable
Other-Semi Structured Interview	Attachment B9 - PMHCA Community Resources SSI - Copy.docx	Yes	Yes	Fillable Fileable
Other-Semi Structured Interview	Attachment B10 - MDRBD Community Resources SSI - Copy.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 204	Number of Respondents for Small Entity: 106

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	204	204
Annual IC Time Burden (Hours)	102	102
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.