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New Facilities 2015-17
2016-17 National Mental Health Services Survey (N-MHSS)
OMB: 0930-0119
IC ID: 202152
OMB.report
HHS/SAMHSA
OMB 0930-0119
ICR 201605-0930-001
IC 202152
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0119 can be found here:
2019-12-02 - Revision of a currently approved collection
2016-12-15 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 2015 N-MHSS-Locato
New Facilities 2015-17
Form and Instruction
2015 N-MHSS-Locato 2015 N-MHSS-Locator Survey Paper Questionnaire
Attachment A2 - 2015 N-MHSS-Locator Survey Paper Questionnaire.docx
Form and Instruction
2016 N-MHSS (Betwe 2016 N-MHSS (Between Survey Update) Paper Questionnaire
Attachment A2 - 2016 N-MHSS (Between Survey Update) Paper Questionnaire.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
New Facilities 2015-17
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
2015 N-MHSS-Locator Survey Paper Questionnaire
2015 N-MHSS-Locator Survey Paper Questionnaire
Attachment A2 - 2015 N-MHSS-Locator Survey Paper Questionnaire.docx
Yes
Yes
Fillable Printable
Form and Instruction
2016 N-MHSS (Between Survey Update) Paper Question
2016 N-MHSS (Between Survey Update) Paper Questionnaire
Attachment A2 - 2016 N-MHSS (Between Survey Update) Paper Questionnaire.pdf
Yes
Yes
Fillable Fileable
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:
1,700
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 New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,700
0
0
0
0
1,700
Annual IC Time Burden (Hours)
714
0
0
0
0
714
Annual IC Cost Burden (Dollars)
0
0
0
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.