Information Collection

Household Screening

IC 43643 under ICR 201011-0930-001 · OMB 0930-0110.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0110 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Survey Household Screening	Form and Instruction
Survey Survey CAI.zip	Form and Instruction
Survey Survey NSDUH_2010_CAI.zip	Form and Instruction
Final Package Attachments.zip Attachments	IC Document
NSDUH_2010_Screener.zip Screener	IC Document
NSDUH_2010_attachments.zip Other Attachments	IC Document
Attachment AA.doc List of Counties	IC Document

IC Title:

Household Screening

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	Survey	Survey	CAI.zip		Yes	Yes	Paper Only
Form and Instruction	Survey	Survey	NSDUH_2010_CAI.zip		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 196,720

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	Previously Approved
Annual Number of Responses for this IC	196,720	5,830	190,890
Annual IC Time Burden (Hours)	16,328	-69,638	85,966
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachments	Final Package Attachments.zip	06/24/2008
Screener	NSDUH_2010_Screener.zip	06/09/2009
Other Attachments	NSDUH_2010_attachments.zip	06/09/2009
List of Counties	Attachment AA.doc	11/15/2010

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