Information Collection

Shared Decision-Making in Mental Health Decision Support Tools

IC 192574 under ICR 200710-0930-001 · OMB 0930-0197.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0197 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Survey #1 Consumer Shared Decision-Making in Mental Health Decision Support Tools	Form and Instruction
Survey #1 Consumer Survey #1 Consumer View of Workbook Survey #1 Consumer View of Workbook.pdf	Form and Instruction
Survey #2 Provider Survey #2 Provider View of Workbook Survey #2 Provider View of Workbook.pdf	Form and Instruction
Survey #3 Consumer Survey #3 Consumer View of Decision Aid Survey #3 Consumer View of Decision Aid.pdf	Form and Instruction
Survey #4 Provider Survey #4 Provider View of Decision Aid Survey #4 Provider View of Decision Aid.pdf	Form and Instruction
OMBTransLet12-2010.wpd Memo	IC Document
OMB Justification.doc Justification	IC Document
Product #1 What is Right for Me Workbook.pdf Product #1 What is Right for Me Workbook	IC Document
Product #2 Supporting Choice Workbook.pdf Product #2 Supporting Choice Workbook	IC Document

IC Title:

Shared Decision-Making in Mental Health Decision Support Tools

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Survey #1 Consumer View of Workbook	Survey #1 Consumer View of Workbook	Survey #1 Consumer View of Workbook.pdf	Yes	Yes	Paper Only
Form and Instruction	Survey #2 Provider View of Workbook	Survey #2 Provider View of Workbook	Survey #2 Provider View of Workbook.pdf	Yes	Yes	Paper Only
Form and Instruction	Survey #3 Consumer View of Decision Aid	Survey #3 Consumer View of Decision Aid	Survey #3 Consumer View of Decision Aid.pdf	Yes	Yes	Paper Only
Form and Instruction	Survey #4 Provider View of Decision Aid	Survey #4 Provider View of Decision Aid	Survey #4 Provider View of Decision Aid.pdf	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 724

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	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	724	0	0	0	0	0
Annual IC Time Burden (Hours)	171	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Memo	OMBTransLet12-2010.wpd	04/12/2010
Justification	OMB Justification.doc	04/12/2010
Product #1 What is Right for Me Workbook	Product #1 What is Right for Me Workbook.pdf	04/12/2010
Product #2 Supporting Choice Workbook	Product #2 Supporting Choice Workbook.pdf	04/12/2010

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