Individual/Family Crisis Counseling Services Encounter Log

Toolkit Protocol for the Crisis Counseling Assistance and Training Program (CCP)

Documents and Forms

Document Name Document Type
Form Individual/Family Individual/Family Crisis Counseling Services Encounter Log Form and Instruction
Individual/Family Individual/Family Crisis Counseling Services Encounter L Attach A dtac-ccp-toolkit-individual-family-encounter-log-20250228-omb-clean.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Individual/Family Crisis Counseling Services Encounter Log	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Individual/Family Crisis Counseling Services Encou	Individual/Family Crisis Counseling Services Encounter Log	Attach A dtac-ccp-toolkit-individual-family-encounter-log-20250228-omb-clean.pdf		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: 800	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	160,000	160,000
Annual IC Time Burden (Hours)	20,800	20,800
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.