Information Collection

Child Mental Health--Line 14

IC 191072 under ICR 200910-0920-008 · OMB 0920-0214.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0214 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 14 Child Mental Health--Line 14	Form and Instruction
14 Child Mental Health--Line 14 NHIS 2010 Attachment 3j Child Mental Health (2 minutes).pdf	Form and Instruction
NHIS 2010 Attachment 3n NHIS 2010 Flashcard Booklet.doc NHIS 2010 Attachment 3n NHIS 2010 Flashcard Booklet	IC Document

IC Title:

Child Mental Health--Line 14

Agency IC Tracking Number:

Is this a Common Form? No

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	14	Child Mental Health--Line 14	NHIS 2010 Attachment 3j Child Mental Health (2 minutes).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population

FR Citation: 49 FR 37693

Number of Respondents: 10,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10,000	10,000
Annual IC Time Burden (Hours)	333	333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NHIS 2010 Attachment 3n NHIS 2010 Flashcard Booklet	NHIS 2010 Attachment 3n NHIS 2010 Flashcard Booklet.doc	10/14/2009

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