988 Crisis Center Follow Up Cooperative Agreements

988 Cooperative Agreements Monitoring Program

Documents and Forms

Document Name Document Type
Form Crisis Center Data 988 Crisis Center Follow Up Cooperative Agreements Form and Instruction
Crisis Center Data Crisis Center Data Reporting Elements Data Reporting Elements 4.5.23.docx Form and Instruction
Crisis Center Data Crisis Center Data Reporting Elements Data Reporting Elements 4.5.23.docx Form and Instruction
Crises Center Foll Crises Center Follow-Up: Semi-Annual Data Table SAMHSA Crisis Contact Center Follow-Up Program - Semi-Annual Data Indicator Table Template (FINAL).docx Form and Instruction
Crises Center Foll Crises Center Follow-Up: Semi-Annual Data Table SAMHSA Crisis Contact Center Follow-Up Program - Semi-Annual Data Indicator Table Template (FINAL).docx Form and Instruction
Crises Center Mont Crises Center Monthly Agenda Template CCFU Monthly meeting agenda revised (FINAL).docx Form and Instruction
Crises Center Mont Crises Center Monthly Agenda Template CCFU Monthly meeting agenda revised (FINAL).docx Form and Instruction

Information Collection (IC) Details

IC Title:	988 Crisis Center Follow Up Cooperative Agreements	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Crisis Center Data Reporting Elements	Crisis Center Data Reporting Elements	Data Reporting Elements 4.5.23.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Crises Center Follow-Up: Semi-Annual Data Table	Crises Center Follow-Up: Semi-Annual Data Table	SAMHSA Crisis Contact Center Follow-Up Program - Semi-Annual Data Indicator Table Template (FINAL).docx	Yes	Yes	Fillable Fileable
Form and Instruction	Crises Center Monthly Agenda Template	Crises Center Monthly Agenda Template	CCFU Monthly meeting agenda revised (FINAL).docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Privacy Act of 1974 (Title 5 United States Code [U.S.C.] 552a)	FR Citation: 75 FR 28264

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	40	20	20
Annual IC Time Burden (Hours)	80	40	40
Annual IC Cost Burden (Dollars)	0	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.