Information Collection

Facilities Universe in 2014 and 2016

IC 7528 under ICR 201311-0930-002 · OMB 0930-0119.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0119 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2014 N-MHSS (Full- Facilities Universe in 2014 and 2016	Form and Instruction
2014 N-MHSS (Full- 2014 N-MHSS (Full-Scale) Paper Questionnaire Attachment A1 - 2014 N-MHSS (Full-Scale) Paper Questionnaire.docx	Form and Instruction
Attachment A4 - 2014 N-MHSS CATI Questionnaire.docx 2014 N-MHSS CATI Questionnaire	IC Document
Attachment A3 - 2014 N-MHSS Web Screens for Online Questionnaire.docx 2014 N-MHSS Web Screens for Online Questionnaire	IC Document
Attachment A5 - 2014 N-MHSS Advance Letter.docx 2014 N-MHSS Advance Letter	IC Document
Attachment A6 - 2014 N-MHSS Cover Letter (First Mailing) and Online Questionnaire Access Instructions_Pg 1.doc 2014 N-MHSS Cover Letter (First Mailing) and Online Questionnaire Access Instructions_Pg 1	IC Document
Attachment A6 - 2014 N-MHSS Cover Letter (First Mailing) and Online Questionnaire Access Instructions_Pg 2.docx 2014 N-MHSS Cover Letter (First Mailing) and Online Questionnaire Access Instructions_Pg 2	IC Document
Attachment A7 - 2014 N-MHSS First Thank You-Reminder Letter.docx 2014 N-MHSS First Thank You-Reminder Letter	IC Document
Attachment A8 - 2014 N-MHSS Second Thank You-Reminder Letter.docx 2014 N-MHSS Second Thank You-Reminder Letter	IC Document
Attachment A9 - 2014 N-MHSS Cover Letter (Second Mailing) and Online Questionnaire Access Instructions_Pg 1.docx 2014 N-MHSS Cover Letter (Second Mailing) and Online Questionnaire Access Instructions_Pg 1	IC Document
Attachment A9 - 2014 N-MHSS Cover Letter (Second Mailing) and Online Questionnaire Access Instructions_Pg 2.docx 2014 N-MHSS Cover Letter (Second Mailing) and Online Questionnaire Access Instructions_Pg 2	IC Document
Attachment A10 - 2014 N-MHSS Thank You Notification for Completed Surveys.docx 2014 N-MHSS Thank You Notification for Completed Surveys	IC Document
Attachment A11 - 2014 N-MHSS Online Information Site Materials_FAQs.docx 2014 N-MHSS Online Information Site Materials_FAQs	IC Document
Attachment A11 - 2014 N-MHSS Online Information Site Materials_Page 1.docx 2014 N-MHSS Online Information Site Materials_Page 1	IC Document
Attachment A12 - List of Expert Panel Members_Nov 2011.docx List of Expert Panel Members_Nov 2011	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Facilities Universe in 2014 and 2016

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	2014 N-MHSS (Full-Scale) Paper Questionnaire	2014 N-MHSS (Full-Scale) Paper Questionnaire	Attachment A1 - 2014 N-MHSS (Full-Scale) Paper Questionnaire.docx		Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 17,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	17,000	2,000	15,000
Annual IC Time Burden (Hours)	12,750	6,450	6,300
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2014 N-MHSS CATI Questionnaire	Attachment A4 - 2014 N-MHSS CATI Questionnaire.docx	11/25/2013
2014 N-MHSS Web Screens for Online Questionnaire	Attachment A3 - 2014 N-MHSS Web Screens for Online Questionnaire.docx	11/25/2013
2014 N-MHSS Advance Letter	Attachment A5 - 2014 N-MHSS Advance Letter.docx	11/25/2013
2014 N-MHSS Cover Letter (First Mailing) and Online Questionnaire Access Instructions_Pg 1	Attachment A6 - 2014 N-MHSS Cover Letter (First Mailing) and Online Questionnaire Access Instructions_Pg 1.doc	11/25/2013
2014 N-MHSS Cover Letter (First Mailing) and Online Questionnaire Access Instructions_Pg 2	Attachment A6 - 2014 N-MHSS Cover Letter (First Mailing) and Online Questionnaire Access Instructions_Pg 2.docx	11/25/2013
2014 N-MHSS First Thank You-Reminder Letter	Attachment A7 - 2014 N-MHSS First Thank You-Reminder Letter.docx	11/25/2013
2014 N-MHSS Second Thank You-Reminder Letter	Attachment A8 - 2014 N-MHSS Second Thank You-Reminder Letter.docx	11/25/2013
2014 N-MHSS Cover Letter (Second Mailing) and Online Questionnaire Access Instructions_Pg 1	Attachment A9 - 2014 N-MHSS Cover Letter (Second Mailing) and Online Questionnaire Access Instructions_Pg 1.docx	11/25/2013
2014 N-MHSS Cover Letter (Second Mailing) and Online Questionnaire Access Instructions_Pg 2	Attachment A9 - 2014 N-MHSS Cover Letter (Second Mailing) and Online Questionnaire Access Instructions_Pg 2.docx	11/25/2013
2014 N-MHSS Thank You Notification for Completed Surveys	Attachment A10 - 2014 N-MHSS Thank You Notification for Completed Surveys.docx	11/25/2013
2014 N-MHSS Online Information Site Materials_FAQs	Attachment A11 - 2014 N-MHSS Online Information Site Materials_FAQs.docx	11/25/2013
2014 N-MHSS Online Information Site Materials_Page 1	Attachment A11 - 2014 N-MHSS Online Information Site Materials_Page 1.docx	11/25/2013
List of Expert Panel Members_Nov 2011	Attachment A12 - List of Expert Panel Members_Nov 2011.docx	11/25/2013

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