Peer Workers Survey

Identifying Core Competencies of Peer Workers in Behavioral Health Services

Documents and Forms

Document Name Document Type
Form Core Competency Su Peer Workers Survey Form
Core Competency Su Core Competency Survey Attachment 1 Core competency survey.docx Form
Attachment 3 Data Collection Protocols.docx Data Collection Protocols IC Document
Attachment 4 Letter to Survey Participants.docx Letter to Survey Participants IC Document

Information Collection (IC) Details

IC Title:	Peer Workers Survey	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	Core Competency Survey	Core Competency Survey	Attachment 1 Core competency survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Data Collection Protocols	Attachment 3 Data Collection Protocols.docx	10/09/2014
Letter to Survey Participants	Attachment 4 Letter to Survey Participants.docx	10/09/2014

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