Information Collection

Retention of Behavior Health Providers Survey

IC 192473 under ICR 201004-0720-001 · OMB 0720-0043.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Letters-Reminders-Phone Script.pdf.pdf	Other-Supplemental Information
Survey Former Providers.docx	Other-Survey

IC Title:

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
Other-Supplemental Information			Letters-Reminders-Phone Script.pdf.pdf		No		Paper Only
Other-Survey			Survey Former Providers.docx		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 164

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	164	164
Annual IC Time Burden (Hours)	41	41
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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