CCBHC Interview Protocol

Evaluation of the Certified Community Behavioral Health Clinic Demonstration in Accordance with the Bipartisan Safer Communities Act

Documents and Forms

Document Name Document Type
Attachment B. CCBHC Demo Eval Clinic Interview Protocol_OMB.docx Instruction
Attachment B. CCBHC Demo Eval Clinic Interview Protocol_OMB.docx Attachment B - CCBHC Clinic Interview IC Document

Information Collection (IC) Details

IC Title:	CCBHC Interview Protocol	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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
Instruction			Attachment B. CCBHC Demo Eval Clinic Interview Protocol_OMB.docx		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

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

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment B - CCBHC Clinic Interview	Attachment B. CCBHC Demo Eval Clinic Interview Protocol_OMB.docx	10/16/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.