Screening Verification

2015 National Survey on Drug Use and Health (NSDUH)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form Scripts Screening Verification Form and Instruction
Scripts Scripts PDF 3 - att M G H.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Screening Verification	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	Scripts	Scripts	PDF 3 - att M G H.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Alcohol, Drug Abuse, and Mental Health Epidemiologic Data (HHS/SAMHSA/OA)	FR Citation: 75 FR 28264

Number of Respondents: 3,755	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	Previously Approved
Annual Number of Responses for this IC	3,755	180	3,575
Annual IC Time Burden (Hours)	252	12	240
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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