Interview

Field Test for the 2012 National Survey on Drug Use and Health (NSDUH)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0334 can be found here:

Documents and Forms

Document Name Document Type
Form Attachment B-CAI Interview Form and Instruction
Attachment B-CAI Attachment B-CAI Attachment B-CAI.pdf Form and Instruction
Attachments A,C,D,E.pdf Attachments A,C,D,E IC Document
Attachments F,G,R,S.pdf Attachments F,G,R,S IC Document
Attachment H.pdf Attachment H IC Document
Attachment I,J.pdf Attachment I,J IC Document
Attachment K.pdf Attachment K IC Document
Attachments L,M,N.pdf Attachments L,M,N IC Document
Attachment O,P-Letters.pdf Attachment O,P-Letters IC Document
Attachment Q.pdf Attachment Q-Refusal Letters IC Document

Information Collection (IC) Details

IC Title:	Interview	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
Form and Instruction	Attachment B-CAI	Attachment B-CAI	Attachment B-CAI.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	2,500	2,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachments A,C,D,E	Attachments A,C,D,E.pdf	05/17/2012
Attachments F,G,R,S	Attachments F,G,R,S.pdf	05/17/2012
Attachment H	Attachment H.pdf	05/17/2012
Attachment I,J	Attachment I,J.pdf	05/17/2012
Attachment K	Attachment K.pdf	05/17/2012
Attachments L,M,N	Attachments L,M,N.pdf	05/17/2012
Attachment O,P-Letters	Attachment O,P-Letters.pdf	05/17/2012
Attachment Q-Refusal Letters	Attachment Q.pdf	05/17/2012

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