Information Collection

Retention of Behavior Health Providers Survey

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

Documents and Forms

Document Name Document Type
Letters-Reminders-Phone Script.pdf.pdf Other-Supplemental Information
Survey Former Providers.docx Other-Survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Retention of Behavior Health Providers Survey	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
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 %

	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

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.