Web Site Registration

Registration for Behavioral Health Web Site and Resources

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0313 can be found here:

Documents and Forms

Document Name Document Type
Form Screenshot of seco Web Site Registration Form and Instruction
Screenshot of seco Screenshot of second web registration form Screenshot of second web registration form.jpg Form and Instruction
Screenshot of firs Screenshot of first web registration form Screenshot of first web registration form.jpg Form and Instruction
Attachment 4 - SAMHSA Data collection questions and Values 3.13 FINAL.doc SAMHSA Data collection questions and Values IC Document

Information Collection (IC) Details

IC Title:	Web Site Registration	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	Screenshot of second web registration form	Screenshot of second web registration form	Screenshot of second web registration form.jpg		Yes	Yes	Fillable Printable
Form and Instruction	Screenshot of first web registration form	Screenshot of first web registration form	Screenshot of first web registration form.jpg		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 38,605	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	38,605	-2,595	41,200
Annual IC Time Burden (Hours)	1,286	-74	1,360
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SAMHSA Data collection questions and Values	Attachment 4 - SAMHSA Data collection questions and Values 3.13 FINAL.doc	06/12/2013

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