Information Collection

Alcoholic Treatment Center Questionnaire

IC 111787 under ICR 197508-0930-001 · OMB 0930-0003.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0003 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	ALCOHOLIC TREATMENT CENTER QUESTIONNAIRE	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

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	NIMH1009				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 286,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	286,000	86,000	200,000
Annual IC Time Burden (Hours)	22,880	3,380	19,500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

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