Information Collection

National Council for Behavioral Health's Information Technology Survey

IC 226612 under ICR 201704-0955-001 · OMB 0955-0017.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 2- Survey Question Crosswalk to Research Questions_4.12.17.docx	Other-survey
Attachment 3- Behavioral Health IT and Interoperability Survey as of 04.13.17 .docx	Other-survey
Attachment 1 - Definitions of Key Terms and Concepts.docx key term	IC Document
Attachment 4-Grantee Letter and BHITS Survey Message to grantees.doc Grantee letter	IC Document
Attachment 5- Survey Data Collection Strategy ONC BH_4.13.17.docx survey strategy	IC Document
Attachment 7- Federal Register, Volume 82 Issue 31 (Thursday, February 16, 2017).htm 60 day FRN	IC Document
Federal Register, Volume 82 Issue 77 (Monday, April 24, 2017).htm 30-day FRN	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Other-survey					Yes	Yes	Fillable Fileable
Other-survey					Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 533

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	533	533
Annual IC Time Burden (Hours)	178	178
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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

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