Information Collection

Facilities Universe in 2016 and 2017

IC 7528 under ICR 201605-0930-001 · OMB 0930-0119.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0119 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2014 N-MHSS (Full- Facilities Universe in 2016 and 2017	Form and Instruction
2014 N-MHSS (Full- 2014 N-MHSS (Full-Scale) Paper Questionnaire Attachment A1 - 2014 N-MHSS (Full-Scale) Paper Questionnaire.docx	Form and Instruction
2016 N-MHSS (Full- 2016 N-MHSS (Full-Scale) Paper Questionnaire Attachment A1 - 2016 N-MHSS (Full-Scale) Paper Questionnaire.pdf	Form and Instruction
Attachment A4 - 2014 N-MHSS CATI Questionnaire.docx 2014 N-MHSS CATI Questionnaire	IC Document
Attachment A3 - 2014 N-MHSS Web Screens for Online Questionnaire.docx 2014 N-MHSS Web Screens for Online Questionnaire	IC Document
Attachment A5 - 2014 N-MHSS Advance Letter.docx 2014 N-MHSS Advance Letter	IC Document
Attachment A6 - 2014 N-MHSS Cover Letter (First Mailing) and Online Questionnaire Access Instructions_Pg 1.doc 2014 N-MHSS Cover Letter (First Mailing) and Online Questionnaire Access Instructions_Pg 1	IC Document
Attachment A6 - 2014 N-MHSS Cover Letter (First Mailing) and Online Questionnaire Access Instructions_Pg 2.docx 2014 N-MHSS Cover Letter (First Mailing) and Online Questionnaire Access Instructions_Pg 2	IC Document
Attachment A7 - 2014 N-MHSS First Thank You-Reminder Letter.docx 2014 N-MHSS First Thank You-Reminder Letter	IC Document
Attachment A8 - 2014 N-MHSS Second Thank You-Reminder Letter.docx 2014 N-MHSS Second Thank You-Reminder Letter	IC Document
Attachment A9 - 2014 N-MHSS Cover Letter (Second Mailing) and Online Questionnaire Access Instructions_Pg 1.docx 2014 N-MHSS Cover Letter (Second Mailing) and Online Questionnaire Access Instructions_Pg 1	IC Document
Attachment A9 - 2014 N-MHSS Cover Letter (Second Mailing) and Online Questionnaire Access Instructions_Pg 2.docx 2014 N-MHSS Cover Letter (Second Mailing) and Online Questionnaire Access Instructions_Pg 2	IC Document
Attachment A10 - 2014 N-MHSS Thank You Notification for Completed Surveys.docx 2014 N-MHSS Thank You Notification for Completed Surveys	IC Document
Attachment A11 - 2014 N-MHSS Online Information Site Materials_FAQs.docx 2014 N-MHSS Online Information Site Materials_FAQs	IC Document
Attachment A11 - 2014 N-MHSS Online Information Site Materials_Page 1.docx 2014 N-MHSS Online Information Site Materials_Page 1	IC Document
Attachment A12 - List of Expert Panel Members_Nov 2011.docx List of Expert Panel Members_Nov 2011	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Facilities Universe in 2016 and 2017

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	2014 N-MHSS (Full-Scale) Paper Questionnaire	2014 N-MHSS (Full-Scale) Paper Questionnaire	Attachment A1 - 2014 N-MHSS (Full-Scale) Paper Questionnaire.docx		Yes	Yes	Fillable Printable
Form and Instruction	2016 N-MHSS (Full-Scale) Paper Questionnaire	2016 N-MHSS (Full-Scale) Paper Questionnaire	Attachment A1 - 2016 N-MHSS (Full-Scale) 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: 17,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	17,000	17,000
Annual IC Time Burden (Hours)	12,750	12,750
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2014 N-MHSS CATI Questionnaire	Attachment A4 - 2014 N-MHSS CATI Questionnaire.docx	11/25/2013
2014 N-MHSS Web Screens for Online Questionnaire	Attachment A3 - 2014 N-MHSS Web Screens for Online Questionnaire.docx	11/25/2013
2014 N-MHSS Advance Letter	Attachment A5 - 2014 N-MHSS Advance Letter.docx	11/25/2013
2014 N-MHSS Cover Letter (First Mailing) and Online Questionnaire Access Instructions_Pg 1	Attachment A6 - 2014 N-MHSS Cover Letter (First Mailing) and Online Questionnaire Access Instructions_Pg 1.doc	11/25/2013
2014 N-MHSS Cover Letter (First Mailing) and Online Questionnaire Access Instructions_Pg 2	Attachment A6 - 2014 N-MHSS Cover Letter (First Mailing) and Online Questionnaire Access Instructions_Pg 2.docx	11/25/2013
2014 N-MHSS First Thank You-Reminder Letter	Attachment A7 - 2014 N-MHSS First Thank You-Reminder Letter.docx	11/25/2013
2014 N-MHSS Second Thank You-Reminder Letter	Attachment A8 - 2014 N-MHSS Second Thank You-Reminder Letter.docx	11/25/2013
2014 N-MHSS Cover Letter (Second Mailing) and Online Questionnaire Access Instructions_Pg 1	Attachment A9 - 2014 N-MHSS Cover Letter (Second Mailing) and Online Questionnaire Access Instructions_Pg 1.docx	11/25/2013
2014 N-MHSS Cover Letter (Second Mailing) and Online Questionnaire Access Instructions_Pg 2	Attachment A9 - 2014 N-MHSS Cover Letter (Second Mailing) and Online Questionnaire Access Instructions_Pg 2.docx	11/25/2013
2014 N-MHSS Thank You Notification for Completed Surveys	Attachment A10 - 2014 N-MHSS Thank You Notification for Completed Surveys.docx	11/25/2013
2014 N-MHSS Online Information Site Materials_FAQs	Attachment A11 - 2014 N-MHSS Online Information Site Materials_FAQs.docx	11/25/2013
2014 N-MHSS Online Information Site Materials_Page 1	Attachment A11 - 2014 N-MHSS Online Information Site Materials_Page 1.docx	11/25/2013
List of Expert Panel Members_Nov 2011	Attachment A12 - List of Expert Panel Members_Nov 2011.docx	11/25/2013

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