2022 PMHCA Program Implementation Survey

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

Documents and Forms

Document Name Document Type
Form 3A 2022 PMHCA Program Implementation Survey Form and Instruction
Form 3A 2022 PMHCA Program Implementation Survey Form and Instruction
3A 2022 PMHCA Program Implementation Survey Attachment B3 - Program Implementation Survey PMHCA3 - Copy.docx Form and Instruction
3A 2022 PMHCA Program Implementation Survey Attachment B3 - Program Implementation Survey PMHCA3 - Copy.docx Form and Instruction

Information Collection (IC) Details

IC Title:	2022 PMHCA Program Implementation Survey	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	3A	2022 PMHCA Program Implementation Survey	Attachment B3 - Program Implementation Survey PMHCA3 - 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: 5	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	5	5
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.