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Community Mental Health Services Block Grant Application Guidance and Instructions, FY 2005-2007
Community Mental Health Services Block Grant Application Guidance and Instructions, FY 2005-2007
OMB: 0930-0168
IC ID: 7545
OMB.report
HHS/SAMHSA
OMB 0930-0168
ICR 200706-0930-001
IC 7545
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0168 can be found here:
2024-12-06 - Revision of a currently approved collection
2023-05-02 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form Attachment 4
Community Mental Health Services Block Grant Application Guidance and Instructions, FY 2005-2007
Form and Instruction
Attachment 4 2008-2010 Application
Attachment4-BG Application with Data Tables 05 28 07pm Final 1.doc
Form and Instruction
Attachment5-Commissioner Transmittal Ltr OMB Final.doc
Attachment 5 - Transmittal Letter
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Community Mental Health Services Block Grant Application Guidance and Instructions, FY 2005-2007
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
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
Attachment 4
2008-2010 Application
Attachment4-BG Application with Data Tables 05 28 07pm Final 1.doc
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
59
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
59 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
59
0
0
0
0
59
Annual IC Time Burden (Hours)
16,595
0
0
-670
0
17,265
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Attachment 5 - Transmittal Letter
Attachment5-Commissioner Transmittal Ltr OMB Final.doc
06/06/2007
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.