Behavioral Health Data for Response Efforts: Interviews with State, Tribal and Local Government Authorities (CSELS)

CDC I-Catalyst Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1158 can be found here:

Documents and Forms

Document Name Document Type
Behavioral Health Data for Response Efforts: Interviews with State, Tribal and Local Government Authorities (CSELS) Form and Instruction
Behavioral Health Data for Response Efforts Interview Pr Interview Guide _CSELS STL_10252017.docx Form and Instruction
ICatalyst SS-A CSELS STL Govt 10252017.docx I-Catalyst Template IC Document
ICatalyst SS-A CSELS STL Govt 10252017.docx Supporting Statement A IC Document

Information Collection (IC) Details

IC Title:	Behavioral Health Data for Response Efforts: Interviews with State, Tribal and Local Government Authorities (CSELS)	Agency IC Tracking Number:	0920-18CT

IC Status: New

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	n/a	Behavioral Health Data for Response Efforts Interview Protocol Guide and Questions	Interview Guide _CSELS STL_10252017.docx		No		Paper Only

Line of Business: Disaster Management

Subfunction: Emergency Response

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: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	900	900

Documents for IC

Title	Document	Date Uploaded
I-Catalyst Template	ICatalyst SS-A CSELS STL Govt 10252017.docx	10/26/2017
Supporting Statement A	ICatalyst SS-A CSELS STL Govt 10252017.docx	10/26/2017

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