Information Collection

Brother, You're on My Mind (BYOMM) Knowledge Attitudes and Believes Form

IC 228634 under ICR 201501-0925-004 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Brother, You're on My Mind (BYOMM) Knowledge Attitudes and Believes Form	Form and Instruction
1 BYOMM KAB Form BYOMM KAB Form_Revised 10.12.17.pdf	Form and Instruction
Fast Track OMB Clerarance - NIMHD BYOMM KAB_10-06-2017.docx Brother, You’re on My Mind (BYOMM) Knowledge Attitudes and Believes Form	IC Document

IC Title:

Brother, You're on My Mind (BYOMM) Knowledge Attitudes and Believes Form

Agency IC Tracking Number:

IC Status: New

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	1	BYOMM KAB Form	BYOMM KAB Form_Revised 10.12.17.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Brother, Youâre on My Mind (BYOMM) Knowledge Attitudes and Believes Form	Fast Track OMB Clerarance - NIMHD BYOMM KAB_10-06-2017.docx	10/13/2017

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