Structured Interview Questionnaire

An Exploration of Peer Recovery Support Services Across State Behavioral Health Systems

Documents and Forms

Document Name Document Type
Form Peer Support Servi Structured Interview Questionnaire Form and Instruction
Peer Support Servi Peer Support Services Interview PeerSupportServices_SurveyRevision_V7_.docx Form and Instruction
Telephone script_PRSS_v5_.docx Telephone script IC Document

Information Collection (IC) Details

IC Title:	Structured Interview Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	Peer Support Services Interview	Peer Support Services Interview	PeerSupportServices_SurveyRevision_V7_.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	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
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Telephone script	Telephone script_PRSS_v5_.docx	03/05/2014

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