Information Collection

Supplemental Mental Health Telephone Questionaire

IC 210239 under ICR 201401-0925-009 · OMB 0925-0626.

Documents and Forms

Document Name Document Type
Form 1 Supplemental Mental Health Telephone Questionaire Form and Instruction
1 Supplemental Mental Health Questionnaire Att_06 Supplemental Mental Health Questionnaire_12042013.pdf Form and Instruction
Att_05 Supplemental Mental Health Telephone Script.pdf Att_05 Supplemental Mental Health Telephone Script IC Document
Att_07 Supplemental Mental Health Questionnaire Thank You Letter.pdf Att_07 Supplemental Mental Health Questionnaire Thank You Letter IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Supplemental Mental Health Telephone Questionaire	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	1	Supplemental Mental Health Questionnaire	Att_06 Supplemental Mental Health Questionnaire_12042013.pdf		Yes	Yes	Fillable Fileable

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	18,400	18,400
Annual IC Time Burden (Hours)	4,600	4,600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att_05 Supplemental Mental Health Telephone Script	Att_05 Supplemental Mental Health Telephone Script.pdf	01/29/2014
Att_07 Supplemental Mental Health Questionnaire Thank You Letter	Att_07 Supplemental Mental Health Questionnaire Thank You Letter.pdf	01/29/2014

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