Facilities Universe in 2017 and 2019

2017-19 National Mental Health Services Survey (N-MHSS)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form Locator Survey Que Facilities Universe in 2017 and 2019 Form and Instruction
Locator Survey Que Locator Survey Questionnaire Attachment A.1 2017 N-MHSS Locator Survey Questionnaire_120616.pdf Form and Instruction
Attachment A.3 BHSIS screenshots for OMB_2017_Locator.pdf Web Screens IC Document
Attachment A.5 N-MHSS CATI questionnaire.pdf CATI Questionnaire IC Document
2017 NMHSS Letters.pdf Letters IC Document
2017 NMHSS Other.pdf Other IC Document

Information Collection (IC) Details

IC Title:	Facilities Universe in 2017 and 2019	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	Locator Survey Questionnaire	Locator Survey Questionnaire	Attachment A.1 2017 N-MHSS Locator Survey Questionnaire_120616.pdf		Yes	Yes	Fillable Fileable

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 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	17,000	0	17,000
Annual IC Time Burden (Hours)	4,760	-7,990	12,750
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Web Screens	Attachment A.3 BHSIS screenshots for OMB_2017_Locator.pdf	12/08/2016
CATI Questionnaire	Attachment A.5 N-MHSS CATI questionnaire.pdf	12/08/2016
Letters	2017 NMHSS Letters.pdf	12/08/2016
Other	2017 NMHSS Other.pdf	12/08/2016

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