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

OMB 0930-0270

Data collection about services delivered and users of the services will be collected from the CCPs through standardized information tools which will then be reported to SAMHSA for appropriate processing and analysis. CCPs will be required to use the tools for data collection throughout the life of the program.

The latest form for Toolkit Protocol for the Crisis Counseling Assistance and Training Program (CCP) expires 2022-07-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form Individual/Family Individual/Family Crisis Counseling Services Encounter Log Form and Instruction
Form Service Provider F Service Provider Feedback Form Form and Instruction
Form Participant Feedba Participant Feedback Form Form and Instruction
Form Adult Assessment a Assessment and Referral Tool Form and Instruction
Form Weekly Tally Sheet Weekly Tally Sheet Form and Instruction
Form Group Encounter Lo Group Encounter Log Form and Instruction
2022 OMB CCP Data Supporting Statement B (SSB)_final_2022-01-12-clean.docx Supporting Statement B
2022 OMB CCP Data Supporting Statement A (SSA)_final_2022-06-30-clean.docx Supporting Statement A
Individual/Family Crisis Counseling Services Encounter Log Form and Instruction
Service Provider Feedback Form Form and Instruction
Participant Feedback Form Form and Instruction
Assessment and Referral Tool Form and Instruction
Weekly Tally Sheet Form and Instruction
Group Encounter Log Form and Instruction

All Historical Document Collections

202206-0930-002 Approved without change	Revision of a currently approved collection	2022-07-01
201901-0930-004 Approved with change	Reinstatement without change of a previously approved collection	2019-01-31
201507-0930-001 Approved without change	Revision of a currently approved collection	2015-07-30
201203-0930-002 Approved with change	Revision of a currently approved collection	2012-03-20
200809-0930-002 Approved with change	Revision of a currently approved collection	2008-09-18
200507-0930-001 Approved with change	New collection (Request for a new OMB Control Number)	2005-07-06

OMB Details

Individual/Family Crisis Counseling Servies Encounter Log

Federal Enterprise Architecture: Health - Public Health Monitoring

Form Individual/Family Encounter Log	Individual/Family Encounter Log	Fillable Fileable Signable	Form
Form Service Provider Feedback Form	Service Provider Feedback Form	Fillable Fileable	Form
Form Child/YOuth Assessment and Referral Tool	Child/YOuth Assessment and Referral Tool	Fillable Fileable	Form
Form Adult Assessment and Referral Tool	Adult Assessment and Referral Tool	Fillable Fileable	Form
Form Weekly Tally Sheet	Weekly Talkly Sheet	Fillable Fileable	Form
Form Group Encounter Log	Group Encounter Log	Fillable Fileable	Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.