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Generic Clearance for Questionnaire Pretesting Research

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National Survey of Psychiatrists Cognitive Testing

OMB: 0607-0725

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2019 NATIONAL
SURVEY OF PSYCHIATRISTS

Start Here

Section A.
Eligibility

Respond online today at:
https://respond.census.gov/nsp

A1.

OR

Are you currently licensed to practice medicine
in the U.S.?
Yes

Complete this form and mail it back
as soon as possible.
The 2019 National Survey of Psychiatrists (NSP)
is being conducted by the United States Census
Bureau on behalf of the Substance Abuse and
Mental Health Services Administration of the U.S.
Department of Health and Human Services.
We appreciate your help with this important
survey. If you need help or have questions about
completing this form, please call 1-888-369-3615
or email us at [email protected].

No ➔ If No, you do not need to complete the
rest of this questionnaire. Please mark
“No” and return this questionnaire in
the envelope provided so we know you
are not eligible.
A2.

Did you complete your residency in psychiatry?
Yes
No ➔ If No, you do not need to complete the
rest of this questionnaire. Please mark
“No” and return this questionnaire in
the envelope provided so we know you
are not eligible.

FORM NSP-1
(11/14/2018)

27039015

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File Titlensp1_19_p01.g
File Modified2018-11-14
File Created2018-11-13

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