Household Screening

National Mental Health Study (NMHS) Field Test

Documents and Forms

Document Name Document Type
Form Screening Question Household Screening Form and Instruction
Screening Question Screening Questions NMHS OMB_PDF 01.pdf Form and Instruction
NMHS OMB_PDF 08.pdf Screening Materials IC Document
Attachment AH NMHS Public Comment.pdf Comment IC Document
Attachment AI Response to Public Comment.pdf Response IC Document

Information Collection (IC) Details

IC Title:	Household Screening	Agency IC Tracking Number:

Is this a Common Form? No		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	Screening Questions	Screening Questions	NMHS OMB_PDF 01.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,331	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,331	2,331
Annual IC Time Burden (Hours)	193	193
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Screening Materials	NMHS OMB_PDF 08.pdf	07/10/2017
Comment	Attachment AH NMHS Public Comment.pdf	07/11/2017
Response	Attachment AI Response to Public Comment.pdf	07/11/2017

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