DBHNA Follow-up

Disaster Technical Assistance Center Disaster Mental Health Needs Assessment and Customer Satisfaction Survey

Documents and Forms

Document Name Document Type
Form Follow-Up Phone In DBHNA Follow-up Form and Instruction
Follow-Up Phone In Follow-Up Phone Interview Guide Attachment A3 NAS 2013 Follow-Up Phone Interview Guide.docx Form and Instruction

Information Collection (IC) Details

IC Title:	DBHNA Follow-up	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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	Follow-Up Phone Interview Guide	Follow-Up Phone Interview Guide	Attachment A3 NAS 2013 Follow-Up Phone Interview Guide.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-50	50
Annual IC Time Burden (Hours)	-38	38
Annual IC Cost Burden (Dollars)	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.